Healthcare Provider Details

I. General information

NPI: 1407852080
Provider Name (Legal Business Name): STEPHEN W HILTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 LONE OAK RD
PADUCAH KY
42003-7901
US

IV. Provider business mailing address

PO BOX 636961
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-0777
  • Fax: 270-443-0999
Mailing address:
  • Phone: 513-981-5098
  • Fax: 513-981-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number22027
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.047375
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: