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Individual

RUDOLPH F LICANDRO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3900 KRESGE WAY, STE 60, LOUISVILLE, KY 40207-4660
(502) 893-7710
(502) 893-1884
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5753

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
23908
KY
207RI0011X
Interventional Cardiology Physician
Primary
23908
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
64239080
KY
Enumeration date
07/11/2005
Last updated
03/07/2023
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