Provider Demographics
NPI:1275687824
Name:STROMBERG, ERIC D (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:STROMBERG
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 1:8008 CHEROKEE LANE
Mailing Address - Street 2:
Mailing Address - City:LEDWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1132
Mailing Address - Country:US
Mailing Address - Phone:913-648-5247
Mailing Address - Fax:
Practice Address - Street 1:8800 BALLENTINE ROAD
Practice Address - Street 2:SHRGILENTA OF JOHNSON COUNTY
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:913-594-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31261207L00000X
KS0419433207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSTH518671Medicaid
C50708Medicare UPIN