Basic Information
| Provider Information | |||||||||
| NPI: | 1861415176 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BREWER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 CHAMBER CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAKESIDE PARK | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410171673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 7370 TURFWAY RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | FLORENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410424895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592120497 | ||||||||
| FaxNumber: | 8592121141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 09/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35.056513 | OH | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 22387 | KY | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 7100310810 | 05 | KY | MEDICAID | 0707408 | 05 | OH | MEDICAID |