Provider Demographics
NPI:1528088242
Name:OWENS, SEAN C (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:C
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:450 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4204
Mailing Address - Country:US
Mailing Address - Phone:502-897-3214
Mailing Address - Fax:502-897-7685
Practice Address - Street 1:1373 E STATE ROAD 62 # LEVEL1
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0130
Practice Address - Fax:812-801-0474
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053396A2085R0202X
KY343772085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200351950Medicaid
KY64347370Medicaid
IN200351950Medicaid
KY1276424Medicare ID - Type UnspecifiedSUBURBAN
KY64347370Medicaid