Basic Information
| Provider Information | |||||||||
| NPI: | 1225093222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALHOUN | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 9342 CEDAR CENTER WAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402914522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022393228 | ||||||||
| FaxNumber: | 5022312517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0011X | 32818 | KY | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | 207Q00000X | 32818 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000350663 | 01 | ANTHEM / NMA | OTHER | 50011928 | 01 | PASSPORT / NMA | OTHER | 64877350 | 05 | KY | MEDICAID | 3701992000 | 01 | PASSPORT ADVANTAGE / NAWCC | OTHER | 50022968 | 01 | PASSPORT / NAWCC | OTHER | 000000606004 | 01 | ANTHEM / NAWCC | OTHER | 1193581 | 01 | CHA / NMA | OTHER | 000052155G | 01 | HUMANA / NMA | OTHER | 3588385001 | 01 | CIGNA / NMA | OTHER | 009694 | 01 | SIHO / NMA | OTHER | 2760466000 | 01 | PASSPORT ADVANTAGE / NMA | OTHER | P00181579 | 01 | KY | RAILROAD MEDICARE | OTHER |