Provider Demographics
NPI:1578604005
Name:STIVERS, STEPHEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:STIVERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3202
Mailing Address - Country:US
Mailing Address - Phone:270-444-9011
Mailing Address - Fax:270-444-9902
Practice Address - Street 1:2000 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3202
Practice Address - Country:US
Practice Address - Phone:270-444-9011
Practice Address - Fax:270-444-9902
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY62186125242003A001OtherWPS TRICARE FOR LIFE
KYKY0057841OtherTRICARE NORTH PROVIDER ID
KY137000OtherHEALTHLINK PROVIDER ID
KY000000204311OtherBLUE CROSS BLUE SHIELD ID
KY62186125242003A001OtherWPS TRICARE FOR LIFE
KYT54166Medicare UPIN