Active NPI
Rudolph F Licandro, M.D.
- Interventional Cardiology Physician
- Louisville, KY
National Provider Identifier
1497753784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Cardiology Physician
- License
- 23908
- Practice address
- 3900 Kresge Way
Ste 60
Louisville, KY 40207-4660 - Phone
- (502) 893-7710
- Fax
- (502) 893-1884
- NPI assigned
- Jul 11, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 23908 | KY | |
| Interventional Cardiology Physician | 207RI0011X | 23908 | KY | Primary |
Addresses
Primary practice location
3900 Kresge Way
Ste 60
Louisville, KY 40207-4660
Mailing address
PO Box 950248
Louisville, KY 40295-0248
Phone (502) 489-5730
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64239080 | Medicaid | KY |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rlicandro7718@bhkydirect.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1497753784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 950248",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402950248",
"telephone_number": "502-489-5730",
"fax_number": "502-489-5753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 KRESGE WAY",
"address_2": "STE 60",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402074660",
"telephone_number": "502-893-7710",
"fax_number": "502-893-1884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICANDRO",
"first_name": "RUDOLPH",
"middle_name": "F",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-11",
"last_updated": "2023-03-07",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "KY",
"license": "23908",
"primary": false
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "KY",
"license": "23908",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64239080",
"state": "KY"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rlicandro7718@bhkydirect.com",
"affiliation": "N",
"address_1": "3900 Kresge Way",
"address_2": "Ste 60",
"city": "Louisville",
"state": "KY",
"country_code": "US",
"postal_code": "402074660",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.