Provider Demographics
NPI:1619532397
Name:GILES, STEPHEN VAN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:VAN
Last Name:GILES
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 1:3066 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-9511
Mailing Address - Country:US
Mailing Address - Phone:270-384-6451
Mailing Address - Fax:270-384-9100
Practice Address - Street 1:3066 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-9511
Practice Address - Country:US
Practice Address - Phone:270-384-6451
Practice Address - Fax:270-384-9400
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty