Provider Demographics
NPI:1922027044
Name:KAELIN, DARRYL L (MD)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:L
Last Name:KAELIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3826
Mailing Address - Country:US
Mailing Address - Phone:502-584-3377
Mailing Address - Fax:502-584-3480
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 1100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-584-3377
Practice Address - Fax:502-584-3480
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056729208100000X
KYTP096208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG12534Medicare UPIN