Provider Demographics
NPI:1033119987
Name:CHMIEL, STANLEY S (MD)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:S
Last Name:CHMIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:S
Other - Last Name:CHMIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4003 KRESGE WAY
Mailing Address - Street 2:STE 227
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-893-3342
Mailing Address - Fax:502-893-9575
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:STE 227
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-3342
Practice Address - Fax:502-893-9575
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21327207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
611005772OtherCHAMPA
1050467OtherPASSPORT HEALTHCARE
240000100OtherRR MEDICARE
10-00015OtherUNITED HEALTHCARE
2502325OtherCIGNA
KY64213275Medicaid
000000047671OtherANTHEM BCBS
240000100OtherRAILROAD MEDICARE
611005772OtherCHAMPA
1324701Medicare PIN