Basic Information
| Provider Information | |||||||||
| NPI: | 1649366949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BADER | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 N L ROGERS WELLS BLVD | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421411300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706595865 | ||||||||
| FaxNumber: | 2706595854 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 N L ROGERS WELLS BLVD | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421411300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706595865 | ||||||||
| FaxNumber: | 2706595854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 62200 | TN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 46596 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7100398480 | 05 | KY | MEDICAID | 201348900 | 05 | IN | MEDICAID |