Provider Demographics
NPI:1174557037
Name:SELF, STEPHEN BENDER (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BENDER
Last Name:SELF
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 1:100 E LIBERTY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-589-3173
Mailing Address - Fax:502-589-6751
Practice Address - Street 1:201 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 1004
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-589-3173
Practice Address - Fax:502-589-6751
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010461962086S0129X
KY247112086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100389000A-KOHMGMedicaid
KY64247117Medicaid
KYP00693361Medicare PIN
KY00546201Medicare Oscar/Certification
KY64247117Medicaid