Provider Demographics
NPI:1982631487
Name:ALLEN, RICHARD D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14755207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50013909OtherRAILROAD MEDICARE- CTS
IN100388670AMedicaid
KY64147556Medicaid
IN100388670FMedicaid
KYP00992175OtherRAILROAD MEDICARE- NCVA
IN100388670BMedicaid
KY1056105OtherPASSPORT PIN
KY000000044923OtherANTHEM PIN
KY060018526Medicaid
IN100388670CMedicaid
KY2433831000OtherPASSPORT ADV PIN
KY008962OtherSIHO- CTS
KY060018526Medicaid
IN100388670CMedicaid
KY060057510Medicare PIN
KY00059008Medicare PIN
KYP00992175OtherRAILROAD MEDICARE- NCVA
KY50013909OtherRAILROAD MEDICARE- CTS
KY0558501Medicare PIN
KY0558206Medicare PIN
KY008962OtherSIHO- CTS