Healthcare Provider Details

I. General information

NPI: 1154346435
Provider Name (Legal Business Name): ROBERT LEE CAUDILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MUHAMMAD ALI BLVD
LOUISVILLE KY
40202-1423
US

IV. Provider business mailing address

2105 CRUMS LN
LOUISVILLE KY
40216-4231
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8600
  • Fax: 502-589-8771
Mailing address:
  • Phone: 502-589-1100
  • Fax: 502-589-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27307
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: