Provider Demographics
NPI:1649317355
Name:TAYLOR, STEPHEN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-479-4433
Mailing Address - Fax:502-451-5949
Practice Address - Street 1:1951 BISHOP LN
Practice Address - Street 2:SUITE 204/206 WATTERSON TOWER
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1930
Practice Address - Country:US
Practice Address - Phone:502-479-4433
Practice Address - Fax:502-451-5949
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY407862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200868780Medicaid
INP01112557OtherRR FOR INDIANA MEDICARE
KY7100014000Medicaid
KYF37210Medicare UPIN
KY00546111Medicare Oscar/Certification
INP01112557OtherRR FOR INDIANA MEDICARE