MEDICARE: ELIZABETH FARMER STUCKER MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	31289	KY
2	208000000X	Pediatrics Physician	31289	KY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00655715	OTHER	KY	RAILROAD MEDICARE- NORTON CMA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000546083	OTHER	KY	ANTHEM
2	4107882	OTHER	KY	CIGNA- NORTON
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	093039	OTHER	KY	SIHO
5	50018657	OTHER	KY	PASSPORT- NORTON CMA
6	3504095000	OTHER	KY	PASSPORT ADVANTAGE- NORTON CMA HURSTBOURNE
8	000023029R	OTHER	KY	HUMANA- NORTON
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	200909250	OTHER	KY	MD WISE- NORTON CMA
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1467438101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH FARMER STUCKER MD

Provider Business Mailing Address
First Line	:	PO BOX 766351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	213 N HURSTBOURNE PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-5139
Country	:	US
Telephone Number	:	502-327-5135
Fax Number	:	502-327-9475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/21/2016