Individual
RICHARD CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 AUDUBON PLAZA DR, LOUISVILLE, KY 40217-1318
(502) 634-6767
(502) 634-6767
Mailing address
PO BOX 36218, LOUISVILLE, KY 40233-6218
(502) 634-6767
(502) 634-6775
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
30482
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000191766
ANTHEM
KY
01
—
1133734
PASSPORT
KY
05
—
200006190
—
IN
01
—
2437806000
PASSPORT ADVANTAGE
KY
05
—
64878341
—
KY
Enumeration date
08/30/2006
Last updated
09/03/2012
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