Healthcare Provider Details

I. General information

NPI: 1265615546
Provider Name (Legal Business Name): STEVEN KENT GANZEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 REGENCY ROAD
LEXINGTON KY
40503-2954
US

IV. Provider business mailing address

280 PASADENA DR
LEXINGTON KY
40503-2925
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-1316
  • Fax: 859-276-3847
Mailing address:
  • Phone: 859-278-1316
  • Fax: 859-276-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number44711-021
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number060836
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number03100
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036-106836
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: