Basic Information
| Provider Information | |||||||||
| NPI: | 1952369621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026292500 | ||||||||
| FaxNumber: | 5026293166 | ||||||||
| Practice Location | |||||||||
| Address1: | 3991 DUTCHMANS LN | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028993366 | ||||||||
| FaxNumber: | 5028993455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 22515 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 200042650 | 05 | IN | MEDICAID | 2559298 | 01 | KY | CIGNA PROVIDER NUMB | OTHER | 4134911 | 01 | KY | AETNA PROVIDER NUMB | OTHER | 000000044842 | 01 | KY | ANTHEM PROVIDER NUMB | OTHER | 000020583D | 01 | KY | HUMANA PROVIDER NUMB | OTHER | 1050396 | 01 | KY | PASSPORT PROVIDER NUMB | OTHER | 64225154 | 05 | KY | MEDICAID | 900000515 | 01 | KY | RAILROAD MEDICARE | OTHER |