Basic Information
| Provider Information | |||||||||
| NPI: | 1619932084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALES | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 940245 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029696552 | ||||||||
| FaxNumber: | 5029693799 | ||||||||
| Practice Location | |||||||||
| Address1: | 5722 OUTER LOOP | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402194156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024927455 | ||||||||
| FaxNumber: | 5029210222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | 36961 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207QA0401X | 01061356A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207R00000X | 36961 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0401X | 36961 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200800610 | 05 | IN | MEDICAID | 000001064309 | 01 | KY | ANTHEM | OTHER | 7100064620 | 05 | KY | MEDICAID |