Provider Demographics
NPI:1093141103
Name:RICHARD KARREL MD PSC
Entity Type:Organization
Organization Name:RICHARD KARREL MD PSC
Other - Org Name:RICHARD KARREL MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KARREL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-541-3652
Mailing Address - Street 1:4912 US HIGHWAY 42
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6349
Mailing Address - Country:US
Mailing Address - Phone:502-429-0414
Mailing Address - Fax:502-429-0415
Practice Address - Street 1:4912 US HIGHWAY 42
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6349
Practice Address - Country:US
Practice Address - Phone:502-429-0414
Practice Address - Fax:502-429-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38508207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC48321Medicare UPIN