Healthcare Provider Details

I. General information

NPI: 1336732858
Provider Name (Legal Business Name): NULEASE PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 OUTER LOOP
LOUISVILLE KY
40219-4156
US

IV. Provider business mailing address

5720 OUTER LOOP
LOUISVILLE KY
40219-4156
US

V. Phone/Fax

Practice location:
  • Phone: 502-492-7455
  • Fax:
Mailing address:
  • Phone: 502-492-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD H CALES
Title or Position: OWNER
Credential: MD
Phone: 270-465-1411