Basic Information
| Provider Information | |||||||||
| NPI: | 1245295310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CATLETT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 2355 POPLAR LEVEL RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026367444 | ||||||||
| FaxNumber: | 5026367340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38986 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000057119M | 01 | KY | HUMANA - NCMA | OTHER | 000000705096 | 01 | KY | ANTHEM-NCMA | OTHER | 50007288 | 01 | KY | PASSPORT MEDICAID MGD CAR | OTHER | 64071905 | 05 | KY | MEDICAID | 201018690 | 05 | IN | MEDICAID | 5993620 | 01 | CIGNA-NCMA | OTHER | 000000364690 | 01 | KY | ANTHUM BCBS | OTHER | 125062 | 01 | KY | SIHO-NCMA | OTHER | P00374090 | 01 | KY | RAILROAD MEDICARE | OTHER | P00925543 | 01 | KY | MEDICARE RAILROAD KY - NCMA | OTHER | 50032648 | 01 | KY | PASSPORT-NCMA | OTHER |