Provider Demographics
NPI:1891768180
Name:STOWERS, KEITH ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLAN
Last Name:STOWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 MEDICAL VILLAGE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5401
Mailing Address - Country:US
Mailing Address - Phone:859-341-1011
Mailing Address - Fax:859-341-7198
Practice Address - Street 1:5495 N BEND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-9378
Practice Address - Country:US
Practice Address - Phone:859-586-9030
Practice Address - Fax:859-334-4373
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23025208000000X
OH35051059208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0635089OtherAETNA
2527987001OtherCIGNA
OH1220581OtherUNITED HEALTH CARE
000000033926OtherANTHEM
KY64230253Medicaid
2527987001OtherCIGNA