# LOUISVILLE CARDIOLOGY MEDICAL GROUP, PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508936261
- **Authorized official:** DR. RUDOLPH F. LICANDRO M.D. (PRESIDENT)
- **Authorized official phone:** (502) 893-7710

## Contact information

- **Practice address:** 3900 KRESGE WAY, SUITE 60, LOUISVILLE, KY 40207-4660
- **Practice address phone:** (502) 893-7710
- **Practice address fax:** (502) 893-1391
- **Mailing address:** 3900 KRESGE WAY, SUITE 60, LOUISVILLE, KY 40207-4660
- **Mailing address phone:** (502) 893-7710
- **Mailing address fax:** (502) 893-1391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | KY | NULL | Yes |
| 174400000X | Specialist | KY | — | Yes |

## Other

- **Enumeration date:** 11/09/2006
- **Last updated:** 03/18/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 65929820 | — | KY |