Provider Demographics
NPI:1427051234
Name:HSIEH, STANLEY HY (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:HY
Last Name:HSIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 ANDREA ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3336
Mailing Address - Country:US
Mailing Address - Phone:270-781-0167
Mailing Address - Fax:270-781-7112
Practice Address - Street 1:1402 ANDREA ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3336
Practice Address - Country:US
Practice Address - Phone:270-781-0167
Practice Address - Fax:270-781-7112
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18958208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64189582Medicaid
KY64189582Medicaid
C63189Medicare UPIN