Healthcare Provider Details

I. General information

NPI: 1396899373
Provider Name (Legal Business Name): STEPHEN J KAVKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 KRESGE WAY SUITE 315
LOUISVILLE KY
40207-4640
US

IV. Provider business mailing address

4001 KRESGE WAY SUITE 315
LOUISVILLE KY
40207-4640
US

V. Phone/Fax

Practice location:
  • Phone: 502-216-3700
  • Fax:
Mailing address:
  • Phone: 502-216-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number33550
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number33550
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number33550
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number33550
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number33550
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: