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Individual

STEPHEN FW CAVANAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2355 POPLAR LEVEL RD, STE.301, LOUISVILLE, KY 40217-1395
(502) 636-0406
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 272-5063
(502) 272-5339

Taxonomy

Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
23372
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201130560
IN
05
7100222610
KY
01
791023
ANTHEM-NCMA
KY
01
K072160
MEDICARE- NCMA ENDO
KY
Enumeration date
10/02/2005
Last updated
11/01/2019
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