Healthcare Provider Details

I. General information

NPI: 1346246873
Provider Name (Legal Business Name): KENNETH HERBERT RICHMOND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 POPLAR LEVEL RD
LOUISVILLE KY
40213-1009
US

IV. Provider business mailing address

PO BOX 950116
LOUISVILLE KY
40295-0116
US

V. Phone/Fax

Practice location:
  • Phone: 502-459-3760
  • Fax: 502-459-3717
Mailing address:
  • Phone: 502-893-0159
  • Fax: 502-213-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number24518
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: