Provider Demographics
NPI:1194766600
Name:NEUSTAT, STEPHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:NEUSTAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:J
Other - Last Name:NEUSTAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 37228
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-7228
Mailing Address - Country:US
Mailing Address - Phone:859-393-1814
Mailing Address - Fax:
Practice Address - Street 1:108 DIAGNOSTIC DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6556
Practice Address - Country:US
Practice Address - Phone:502-227-5171
Practice Address - Fax:502-227-0131
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00000018169OtherBLUE CROSS & BLUE SHIELD
KY64010796Medicaid
KY1862101Medicare ID - Type UnspecifiedKY MEDICARE
KY00000018169OtherBLUE CROSS & BLUE SHIELD