RUDOLPH F LICANDRO (NPI# 1497753784) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497753784 |
| Entity Type | Individual |
| Full Name | RUDOLPH F LICANDRO |
| Credential | M.D. |
| Practice Address |
3900 Kresge Way Ste 60 Louisville KY 40207-4660 |
| Mailing Address |
Po Box 950248 Louisville KY 40295-0248 |
| Practice Telephone | 5028937710 |
| Practice Fax Number | 5028931884 |
| Mailing Telephone | 5024895730 |
| Mailing Fax Number | 5024895753 |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2015-01-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
23908 | KY | Allopathic & Osteopathic Physicians |
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
23908 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 64239080 | 05 | |
| DEA | AL3044512 | 01 |
| Street Address |
3900 KRESGE WAY STE 60 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40207-4660 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225032014 | Anthony George Jr. | Specialist | 3900 Kresge Way, Suite 31, Louisville, KY 40207-4660 | 2005-06-09 |
| 1821649849 | Amanda Hellmueller | Nurse Practitioner | 3900 Kresge Way, Louisville, KY 40207-4660 | 2019-09-20 |
| 1063948677 | Lyndsay P Delaney | Nurse Practitioner | 3900 Kresge Way, Suite 46, Louisville, KY 40207-4660 | 2017-05-03 |
| 1902343957 | Susette R Roark | Nurse Practitioner | 3900 Kresge Way, Ste 46, Louisville, KY 40207-4660 | 2017-01-30 |
| 1194198077 | Emily Dubois Hollander | Midwife | 3900 Kresge Way, Suite 30, Louisville, KY 40207-4660 | 2015-11-02 |
| 1932503919 | Rose Ballard | Nurse Practitioner | 3900 Kresge Way, Suite 56, Louisville, KY 40207-4660 | 2014-10-20 |
| 1508104258 | Tabitha Satterly-welborn | Nurse Practitioner | 3900 Kresge Way, Suite 46, Louisville, KY 40207-4660 | 2013-01-30 |
| 1023361003 | Kristen Rae Hord | Physician Assistant | 3900 Kresge Way, Ste 30, Louisville, KY 40207-4660 | 2012-10-16 |
| 1710238001 | Kaitlin Sullivan | Physician Assistant | 3900 Kresge Way, Suite 30, Louisville, KY 40207-4660 | 2012-09-26 |
| 1538415070 | Diana Blevins | Nurse Practitioner | 3900 Kresge Way, Ste.46, Louisville, KY 40207-4660 | 2012-08-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780212688 | Alexia Louise Bodamer | Student in an Organized Health Care Education/Training Program | 142 Chenoweth Lane, Lousiville, KY 40207 | 2020-03-28 |
| 1467918664 | Amy Rock LLC | Counselor | 4010 Dupont Cir Ste 307, Louisville, KY 40207 | 2019-02-13 |
| 1649745191 | Louisville Optometric Center, IIi, Psc | Optometrist | 285 Hubbards Lane, Suite 300, Louisville, KY 40207 | 2018-10-11 |
| 1184137440 | Crimson Dove Counseling Services Inc | Community/Behavioral Health | 214 Breckenridge Ln., Suite 203, Louisville, KY 40207 | 2017-11-09 |
| 1285157586 | Dickerson Family Enterprise, LLC | Non-emergency Medical Transport (VAN) | 4350 Brownsboro Rd., Ste. 110, Louisville, KY 40207 | 2017-07-19 |
| 1578085296 | Cardiovascular Medical Specialists LLC | Surgery | 100 Mallard Creek Rd Ste 150, Louisville, KY 40207 | 2017-07-14 |
| 1932636305 | Devon Turley | Prevention Professional | 1017 Dupont Rd, Suite 1, Louisville, KY 40207 | 2017-05-17 |
| 1285095539 | Emily Schwartz Crouch | Marriage & Family Therapist | 4010 Dupont Circle, Suite 582, Louisville, KY 40207 | 2016-03-15 |
| 1306201280 | A A and Associates Approved Alcohol/drug Program | Counselor | 4006 Dutchmans Lane, Louisville, KY 40207 | 2015-12-21 |
| 1629433693 | Jewish Hospital and St. Mary's Healthcare, Inc. | General Acute Care Hospital | 3290 Dutchmans Lane, Louisville, KY 40207 | 2015-12-17 |
| Find all providers in zip 40207 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831300797 | Medical Center Cardiologists, Psc | Internal Medicine | 100 Mallard Creek Rd, Suite 150, Louisville, KY 40207-4194 | 2007-05-24 |
| 1356411508 | Jacob Lawrence Nunamaker Iv | Internal Medicine | 6420 Dutchmans Pkwy, Ste 200, Louisville, KY 40205-3372 | 2006-11-08 |
| 1437267663 | Abdolreza Agahtehrani | Internal Medicine | 6420 Dutchmans Pkwy, Ste 200, Louisville, KY 40205-3372 | 2006-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093250615 | Advanced Vascular Institute | Internal Medicine | 1374 Highway 192 E, London, KY 40741-3123 | 2017-01-05 |
| 1659770733 | Scott C Harris Do Pllc | Internal Medicine | 112 Windmere Dr, Bowling Green, KY 42103-8720 | 2014-08-14 |
| 1457554750 | Tullio Emanuele Md, Psc | Internal Medicine | 720 Second Street, Suite 204, Bowling Green, KY 42101-5852 | 2007-06-06 |
| 1083823421 | Our Lady of Bellefonte Hospital | Internal Medicine | 1180 Saint Christopher Dr, Ste. 2, Ashland, KY 41101-7055 | 2007-05-22 |
| 1750359857 | Michele A Friday | Internal Medicine | 1180 Saint Christopher Dr Ste 2, Ashland, KY 41101-7055 | 2006-03-14 |
| 1740255314 | Avichai Eres | Internal Medicine | 161 N Eagle Creek Dr, Suite 400, Lexington, KY 40509-9038 | 2006-02-17 |
| 1053310409 | Mohammed Kazimuddin | Internal Medicine | 825 Second Ave, Ste B1, Bowling Green, KY 42101 | 2005-07-19 |
| 1235645607 | Appalachian Vascular Institute, Pllc | Internal Medicine | 243 Roy Campbell Dr Ste B, Hazard, KY 41701-9485 | 2017-12-21 |
| 1770001877 | Owensboro Health Medical Group, Inc. | Internal Medicine | 2025 W Everly Brothers Blvd, Powderly, KY 42367-5401 | 2017-09-08 |
| 1346788023 | Julie Reinstatler | Internal Medicine | 800 Rose St, Lexington, KY 40536-7001 | 2017-02-02 |
| Find all providers with the same taxonomy | ||||
| City | LOUISVILLE |
| Zip Code | 40207 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.