Basic Information
| Provider Information | |||||||||
| NPI: | 1871024869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RICHARD-EVERELL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 S LIMESTONE | ||||||||
| Address2: | ROOM K403 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592183044 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF KENTUCKY 800 ROSE STREET | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593232636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | R4590 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.