Provider Demographics
NPI:1518052356
Name:KWAN, STEPHEN K (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
Last Name:KWAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1758 PARK PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1127
Mailing Address - Country:US
Mailing Address - Phone:334-264-7156
Mailing Address - Fax:334-264-7681
Practice Address - Street 1:1758 PARK PL
Practice Address - Street 2:SUITE 202
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1127
Practice Address - Country:US
Practice Address - Phone:334-264-7156
Practice Address - Fax:334-264-7681
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL23435208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF79504Medicare UPIN