Provider Demographics
NPI:1790703007
Name:MONNIG, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:MONNIG
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 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4361
Mailing Address - Fax:859-258-4329
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4361
Practice Address - Fax:859-258-4329
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30574208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYASC1019OtherMEDICARE ASC GROUP
KY37903705OtherMEDICAID LAB GROUP
KY36000818OtherMEDICAID ASC GROUP
KY4000501OtherMEDICARE GROUP NUMBER
KY64305741Medicaid
CB5773OtherRR MEDICARE GROUP
KY36000818OtherMEDICAID ASC GROUP
KY37903705OtherMEDICAID LAB GROUP