Basic Information
| Provider Information | |||||||||
| NPI: | 1215137500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALDWELL | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7145 E VIRGINIA ST STE 2000 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477159147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129627894 | ||||||||
| FaxNumber: | 8124766162 | ||||||||
| Practice Location | |||||||||
| Address1: | 1048 ASHLEY ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421032449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002431455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD446484 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 51656 | KY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100539850 | 05 | KY | MEDICAID |