Provider Demographics
NPI:1154386241
Name:CALLIHAN JR, RICHARD L (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:CALLIHAN JR
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 1:10525 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4401
Mailing Address - Country:US
Mailing Address - Phone:513-745-9800
Mailing Address - Fax:513-985-2905
Practice Address - Street 1:10525 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4401
Practice Address - Country:US
Practice Address - Phone:513-745-9800
Practice Address - Fax:513-985-2905
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086501207R00000X, 207RC0000X
OH35-065501207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64110984Medicaid
OH2595919Medicaid
IN200531430Medicaid
OH2595919Medicaid
IN200531430Medicaid
OHCA4167321Medicare ID - Type Unspecified
KY64110984Medicaid