Provider Demographics
NPI:1619974805
Name:DRAPER, STEPHEN S (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:DRAPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:859-885-9402
Mailing Address - Fax:859-887-1624
Practice Address - Street 1:1250 KEENE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-7600
Practice Address - Country:US
Practice Address - Phone:859-885-9402
Practice Address - Fax:859-887-1624
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY17955208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65928590Medicaid
KYC70438Medicare UPIN
KY65928590Medicaid
KY00926001Medicare PIN