Provider Demographics
NPI:1487647616
Name:REISS, STEVEN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:REISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:STE 51
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-891-8981
Practice Address - Fax:502-891-4548
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22983207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3113110OtherCIGNA - NNIKY
KY3698196000OtherPASSPORT ADVTG - NNIKY
KYP00706057OtherRAILROAD MEDICARE - KY
KY64229834Medicaid
IN100365890Medicaid
KY000000604818OtherANTHEM - NNIKY
KY000023035MOtherHUMANA - NNIKY
KY102718OtherSIHO - NNIKY
KY50022670OtherPASSPORT - NNIKY
KY102718OtherSIHO - NNIKY
IN100365890Medicaid
KY64229834Medicaid
E01335Medicare UPIN
KY1840202Medicare ID - Type Unspecified