Individual
GINA M SPARACINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-5851
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0330
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
03062
IA
207L00000X
Anesthesiology Physician
Primary
04087
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03062
TRICARE PROVIDER #
IA
01
—
04087
STATE LICENSE
KY
01
—
050068372
RAILROAD MEDICARE #
IA
01
—
11360
MIDLANDS PROVIDER #
IA
05
—
1148205
—
IA
05
—
300024863
—
IN
01
—
48055
BLUE SHIELD PROVIDER #
IA
05
—
7100584030
—
KY
01
—
IA0173
JOHN DEERE PROVIDER #
IA
01
—
K292620
MEDICARE
KY
Enumeration date
12/21/2005
Last updated
05/14/2019
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