Provider Demographics
NPI:1689967259
Name:ZELLER, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:ZELLER
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 1:480 HOPKINSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1124
Mailing Address - Country:US
Mailing Address - Phone:270-338-5777
Mailing Address - Fax:270-338-5765
Practice Address - Street 1:1497 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276
Practice Address - Country:US
Practice Address - Phone:270-726-9568
Practice Address - Fax:270-726-9570
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46370207Q00000X, 207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100218010Medicaid
KY7100218010Medicaid
KY181886Medicare Oscar/Certification