Basic Information
| Provider Information | |||||||||
| NPI: | 1740328178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | KIRK | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4123 DUTCHMANS LN | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025847525 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 43341 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 43341 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 9662652 | 01 | NLS/CIGNA | OTHER | 50029766 | 01 | NLS/PHP | OTHER | 000052154Y | 01 | NLS/HUMANA | OTHER | 117506 | 01 | NLS/SIHO | OTHER | 200995020 | 05 | IN | MEDICAID | 7100126910 | 05 | KY | MEDICAID | 000000672943 | 01 | NLS/ANTHEM | OTHER | 9077569 | 01 | NLS/AETNA | OTHER |