Organization
LOUISVILLE CARDIOLOGY MEDICAL GROUP, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUDOLPH F. LICANDRO M.D. (PRESIDENT)
(502) 893-7710
Entity
Organization
Contact information
Practice address
3900 KRESGE WAY, SUITE 60, LOUISVILLE, KY 40207-4660
(502) 893-7710
(502) 893-1391
Mailing address
3900 KRESGE WAY, SUITE 60, LOUISVILLE, KY 40207-4660
(502) 893-7710
(502) 893-1391
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
KY
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65929820
—
KY
Enumeration date
11/09/2006
Last updated
03/18/2010
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