Provider Demographics
NPI:1861480741
Name:TREVATHAN, STEVEN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
Last Name:TREVATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 480W
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-762-1512
Mailing Address - Fax:270-752-2862
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 107E
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-762-1512
Practice Address - Fax:270-752-2862
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY21475208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64214752Medicaid
KY64214752Medicaid
1437001Medicare ID - Type Unspecified