Basic Information
| Provider Information | |||||||||
| NPI: | 1982631487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | RICHARD | ||||||||
| 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: | 6420 DUTCHMANS PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402053372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028918300 | ||||||||
| FaxNumber: | 5028918338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 14755 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 50013909 | 01 | KY | RAILROAD MEDICARE- CTS | OTHER | 100388670A | 05 | IN | MEDICAID | 64147556 | 05 | KY | MEDICAID | 100388670F | 05 | IN | MEDICAID | P00992175 | 01 | KY | RAILROAD MEDICARE- NCVA | OTHER | 100388670B | 05 | IN | MEDICAID | 1056105 | 01 | KY | PASSPORT PIN | OTHER | 000000044923 | 01 | KY | ANTHEM PIN | OTHER | 060018526 | 05 | KY | MEDICAID | 100388670C | 05 | IN | MEDICAID | 2433831000 | 01 | KY | PASSPORT ADV PIN | OTHER | 008962 | 01 | KY | SIHO- CTS | OTHER |