MEDICARE: KENNETH HERBERT RICHMOND M.D.

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	174400000X	Specialist		KY
2	207Y00000X	Otolaryngology Physician	24518	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000045107	OTHER	KY	BCBS

General Provider Information

NPI Number	:	1346246873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH HERBERT RICHMOND M.D.

Provider Business Mailing Address
First Line	:	PO BOX 950116
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0116
Country	:	US
Telephone Number	:	502-893-0159
Fax Number	:	502-213-3884

Provider Business Practice Location Address
First Line	:	3515 POPLAR LEVEL RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-1009
Country	:	US
Telephone Number	:	502-459-3760
Fax Number	:	502-459-3717

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	06/02/2014

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