Provider Demographics
NPI:1427045723
Name:CAVANAH, STEPHEN FW (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FW
Last Name:CAVANAH
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5063
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:STE.301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-636-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23372207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY791023OtherANTHEM-NCMA
KYK072160OtherMEDICARE- NCMA ENDO
IN201130560Medicaid
KY7100222610Medicaid
KY7100222610Medicaid