Individual
MR. CHRISTODULOS STEFANATOS STAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
01035475A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
24509
KY
207RC0001X
Clinical Cardiac Electrophysiology Physician
24509
KY
207RI0011X
Interventional Cardiology Physician
24509
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000052133
ANTHEM BCBS
KY
01
—
060052921
RAILROAL MEDICARE/TVILLE
KY
01
—
060052924
RAILROAD MEDICARE
KY
01
—
060053877
RAILROAD MEDICARE/MADISON
IN
01
—
1052057
PASSPORT HEALTH PLAN
—
05
—
200040930
—
IN
01
—
25-00167
UNITED HEALTHCARE
KY
01
—
299856
FEDERAL BLACK LUNG PROGRA
—
01
—
415633P
SIHO HEALTH PLAN
KY
05
—
64245095
—
KY
01
—
687915
FIRST HEALTH
—
Enumeration date
10/27/2006
Last updated
06/14/2023
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