Individual
GERASIMOS S STAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MALLARD CREEK RD, SUITE 150, LOUISVILLE, KY 40207-4194
(502) 589-7907
(502) 589-1319
Mailing address
100 MALLARD CREEK RD, SUITE 150, LOUISVILLE, KY 40207-4194
(502) 589-7907
(502) 589-1319
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
38382
KY
207RC0001X
Clinical Cardiac Electrophysiology Physician
38382
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000909758
ANTHEM
—
01
—
060052921
RAILROAD MEDICARE
KY
05
—
200198560A
—
OK
05
—
201275370
—
IN
05
—
7100326390
—
KY
01
—
P01433982
RAILROAD MEDICARE
IN
Enumeration date
03/13/2007
Last updated
10/27/2020
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