Provider Demographics
NPI:1760469183
Name:DONOVAN, STUART LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:LEE
Last Name:DONOVAN
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 1:1270 SOLUTIONS CENTER
Mailing Address - Street 2:PO BOX 771270
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1002
Mailing Address - Country:US
Mailing Address - Phone:513-542-6898
Mailing Address - Fax:513-542-7972
Practice Address - Street 1:7502 STATE RD
Practice Address - Street 2:STE. 1180
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2800
Practice Address - Country:US
Practice Address - Phone:513-232-8181
Practice Address - Fax:513-624-2956
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061291208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000002198OtherANTHEM
OH020034065OtherRAILROAD MEDICARE
OH0647990OtherAETNA
OH0836402Medicaid
OH743188OtherBUCKEYE
OH299865OtherAMERIGROUP
OH020034065OtherRAILROAD MEDICARE
OH0647990OtherAETNA
OH0836402Medicaid