MEDICARE: KENNETH D CALHOUN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	32818	KY
2	207Q00000X	Family Medicine Physician	32818	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00181579	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000606004	OTHER	ANTHEM / NAWCC
3	000000350663	OTHER	ANTHEM / NMA
4	50022968	OTHER	PASSPORT / NAWCC
5	000052155G	OTHER	HUMANA / NMA
6	3701992000	OTHER	PASSPORT ADVANTAGE / NAWCC
7	009694	OTHER	SIHO / NMA
8	50011928	OTHER	PASSPORT / NMA
9	3588385001	OTHER	CIGNA / NMA
10	1193581	OTHER	CHA / NMA
11	2760466000	OTHER	PASSPORT ADVANTAGE / NMA
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225093222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH D CALHOUN MD

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	9342 CEDAR CENTER WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4522
Country	:	US
Telephone Number	:	502-239-3228
Fax Number	:	502-231-2517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	09/20/2024

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