Provider Demographics
NPI:1467438101
Name:STUCKER, ELIZABETH FARMER (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FARMER
Last Name:STUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 766351
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:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:213 N HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5139
Practice Address - Country:US
Practice Address - Phone:502-327-5135
Practice Address - Fax:502-327-9475
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31289207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000546083OtherANTHEM
KY4107882OtherCIGNA- NORTON
KY6487966100Medicaid
KY093039OtherSIHO
KY50018657OtherPASSPORT- NORTON CMA
KY3504095000OtherPASSPORT ADVANTAGE- NORTON CMA HURSTBOURNE
KYP00655715OtherRAILROAD MEDICARE- NORTON CMA
KY000023029ROtherHUMANA- NORTON
KY200909250OtherMEDICAID IN- NORTON CMA
KY200909250OtherMD WISE- NORTON CMA
KY200909250OtherANTHEM INDIANA MEDICAID- NORTON CMA
KY200909250OtherANTHEM INDIANA MEDICAID- NORTON CMA
KY00533003Medicare PIN