Provider Demographics
NPI:1740248806
Name:SPALDING, STEVEN LEE (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEE
Last Name:SPALDING
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9342 CEDAR CENTER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4522
Practice Address - Country:US
Practice Address - Phone:502-239-3228
Practice Address - Fax:502-231-2517
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24598207Q00000X
TN245982084P0800X, 2084P0804X
KY26761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3077229OtherAETNA
TN4025500OtherBLUE CROSS/BLUE SHIELD
080178644OtherRAILROAD MEDICARE
TN100029694OtherPHP TENNCARE
KY000057058JOtherHUMANA-CMA
TN01-41818OtherUNITED HEALTH CARE
KY120590OtherSIHO-CMA
TN2522947OtherCIGNA
KY2522947OtherCIGNA-CMA
TN3022710Medicaid
KY50030676OtherPASSPORT-CMA
KY7100140060Medicaid
KYP00912399OtherRR MEDICARE PTAN-COMMUNIT MEDICAL ASSOCIATES
KY000000684412OtherANTHEM-CMA
080178644OtherRAILROAD MEDICARE
F15670Medicare UPIN
080178644OtherRAILROAD MEDICARE
KY61-1276316OtherCMA TAX ID
KYP00912399OtherRR MEDICARE PTAN-COMMUNIT MEDICAL ASSOCIATES