Healthcare Provider Details

I. General information

NPI: 1295732055
Provider Name (Legal Business Name): STEVEN A RUPERT D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/25/2025
Certification Date: 07/17/2025
Deactivation Date: 03/20/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

5925 OLD HWY 60 WEST SUITE D
PADUCAH KY
42001
US

IV. Provider business mailing address

5925 OLD HWY 60 WEST SUITE D
PADUCAH KY
42001
US

V. Phone/Fax

Practice location:
  • Phone: 270-228-0118
  • Fax: 270-228-0120
Mailing address:
  • Phone: 270-228-0118
  • Fax: 270-228-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number02001097
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: