Provider Demographics
NPI:1700837770
Name:DEMUNBRUN, STEVEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:DEMUNBRUN
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 HARDIN LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3812
Mailing Address - Country:US
Mailing Address - Phone:606-677-6886
Mailing Address - Fax:606-677-0017
Practice Address - Street 1:100 HARDIN LANE
Practice Address - Street 2:SUITE D
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3812
Practice Address - Country:US
Practice Address - Phone:606-677-6886
Practice Address - Fax:606-677-0017
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27469208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64274699Medicaid
KY1569001Medicare PIN
KY64274699Medicaid