Healthcare Provider Details

I. General information

NPI: 1477257996
Provider Name (Legal Business Name): PATRICK STALCUP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARK ST
BOWLING GREEN KY
42101-1795
US

IV. Provider business mailing address

303 GOLFVIEW WAY
BOWLING GREEN KY
42104-8584
US

V. Phone/Fax

Practice location:
  • Phone: 270-745-1000
  • Fax:
Mailing address:
  • Phone: 270-406-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTP163
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: