Healthcare Provider Details

I. General information

NPI: 1487758983
Provider Name (Legal Business Name): SCHEEN & SMITH, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 KRESGE WAY SUITE 305
LOUISVILLE KY
40207-4637
US

IV. Provider business mailing address

3950 KRESGE WAY SUITE 305
LOUISVILLE KY
40207-4637
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-8803
  • Fax: 502-896-8863
Mailing address:
  • Phone: 502-896-8803
  • Fax: 502-896-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number17338
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number17338
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number17338
License Number StateKY

VIII. Authorized Official

Name: DR. STEPHEN Z SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-896-8803