1225093222 NPI number — KENNETH D CALHOUN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225093222 NPI number — KENNETH D CALHOUN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CALHOUN

Provider First Name:

KENNETH

Provider Middle Name:

D

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1225093222

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/11/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 776351

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CHICAGO

Provider Business Mailing Address State Name:

IL

Provider Business Mailing Address Postal Code:

60677-6351

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

502-588-9490

Provider Business Mailing Address Fax Number:

502-272-5116

Provider First Line Business Practice Location Address:

9342 CEDAR CENTER WAY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LOUISVILLE

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

40291-4522

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

502-239-3228

Provider Business Practice Location Address Fax Number:

502-231-2517

Provider Enumeration Date:

04/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2083P0011X , with the licence number:  32818 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 32818 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000000350663 . This is a "ANTHEM / NMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 50011928 . This is a "PASSPORT / NMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 64877350 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 3701992000 . This is a "PASSPORT ADVANTAGE / NAWCC" identifier . This identifiers is of the category "OTHER".
• Identifier: 50022968 . This is a "PASSPORT / NAWCC" identifier . This identifiers is of the category "OTHER".
• Identifier: 000000606004 . This is a "ANTHEM / NAWCC" identifier . This identifiers is of the category "OTHER".
• Identifier: 1193581 . This is a "CHA / NMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 000052155G . This is a "HUMANA / NMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 3588385001 . This is a "CIGNA / NMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 009694 . This is a "SIHO / NMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2760466000 . This is a "PASSPORT ADVANTAGE / NMA" identifier . This identifiers is of the category "OTHER".
• Identifier: P00181579 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".