Healthcare Provider Details

I. General information

NPI: 1891768180
Provider Name (Legal Business Name): KEITH ALLAN STOWERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 N BEND RD SUITE 101
BURLINGTON KY
41005-9378
US

IV. Provider business mailing address

20 MEDICAL VILLAGE DR SUITE 102
EDGEWOOD KY
41017-5401
US

V. Phone/Fax

Practice location:
  • Phone: 859-586-9030
  • Fax: 859-334-4373
Mailing address:
  • Phone: 859-341-1011
  • Fax: 859-341-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23025
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35051059
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: