Organization
CARDIOVASCULAR SPECIALISTS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTODULOS S STAVENS MD (PRESIDENT)
(502) 589-7907
Entity
Organization
Contact information
Practice address
100 MALLARD CREEK RD, SUITE 150, LOUISVILLE, KY 40207-5138
(502) 589-7907
(502) 589-1319
Mailing address
100 MALLARD CREEK RD, SUITE 150, LOUISVILLE, KY 40207-5138
(502) 589-7907
(502) 589-1319
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093228
PASSPORT HEALTH PLAN
KY
05
—
200208100
—
IN
05
—
65931560
—
KY
01
—
CI6702
RAILROAD MEDICARE
KY
01
—
CI7476
RAILROAD MEDICARE
IN
Enumeration date
07/18/2006
Last updated
06/30/2015
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