Provider Demographics
NPI:1851440887
Name:CONROTTO, STEVEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:CONROTTO
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 1:385 H HALE DR
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:KY
Mailing Address - Zip Code:41216-8805
Mailing Address - Country:US
Mailing Address - Phone:606-789-7492
Mailing Address - Fax:
Practice Address - Street 1:801 N.MAIN STR.
Practice Address - Street 2:FAITH FAMILY PRACTICE
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-1021
Practice Address - Country:US
Practice Address - Phone:606-743-1422
Practice Address - Fax:606-743-3044
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64698848Medicaid
KY64698848Medicaid