Provider Demographics
NPI:1457385817
Name:PARK, STEVEN EARL (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:EARL
Last Name:PARK
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 1:10506 MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-865-5120
Mailing Address - Fax:513-865-5121
Practice Address - Street 1:10506 MONTGOMERY ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-865-5120
Practice Address - Fax:513-865-5121
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065137P208600000X, 208G00000X
KY29550208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1820063OtherUNITED HEALTHCARE
KY64951494Medicaid
000000005455OtherANTHEM
310804060038OtherCARESOURCE
65137OtherCHOICE CARE/HUMANA
OH0932816Medicaid
IN200058030AMedicaid
8330OtherKY BCBS
65137OtherCHOICE CARE/HUMANA
780001124Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY64951494Medicaid
KY0677801Medicare ID - Type UnspecifiedKY MEDICARE
OH0745751Medicare PIN
8330OtherKY BCBS
780001124Medicare PIN