Provider Demographics
NPI:1477564813
Name:ROSZELL, STEPHEN RHODES (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RHODES
Last Name:ROSZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1169 EASTERN PKWY STE 1234
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1462
Practice Address - Country:US
Practice Address - Phone:502-454-9515
Practice Address - Fax:502-454-8313
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64066038Medicaid
IN201132630Medicaid
IN201132630Medicaid
KYH82723Medicare UPIN
KY00546079Medicare Oscar/Certification