Provider Demographics
NPI:1295732055
Name:RUPERT, STEVEN A (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:RUPERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 VILLAGE SQUARE DR STE C
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7448
Mailing Address - Country:US
Mailing Address - Phone:270-228-0118
Mailing Address - Fax:270-228-0120
Practice Address - Street 1:5925 OLD HWY 60
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001
Practice Address - Country:US
Practice Address - Phone:270-228-0118
Practice Address - Fax:270-228-0120
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2025-04-29
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
IN020010972081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200850420AMedicaid
IN64873391Medicaid
IN100179690Medicaid
IN64873391Medicaid
IN100179690Medicaid
IN6333060001Medicare NSC