Healthcare Provider Details

I. General information

NPI: 1619932084
Provider Name (Legal Business Name): RICHARD H CALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 OUTER LOOP
LOUISVILLE KY
40219-4156
US

IV. Provider business mailing address

P O BOX 940245
LOUISVILLE KY
40295-0001
US

V. Phone/Fax

Practice location:
  • Phone: 502-492-7455
  • Fax: 502-921-0222
Mailing address:
  • Phone: 502-969-6552
  • Fax: 502-969-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number36961
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number01061356A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36961
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number36961
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: