Provider Demographics
NPI:1457312787
Name:GEDULDIG, STEVEN B (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:GEDULDIG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2229
Mailing Address - Country:US
Mailing Address - Phone:913-677-3600
Mailing Address - Fax:913-432-7624
Practice Address - Street 1:153 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5300
Practice Address - Country:US
Practice Address - Phone:913-829-6800
Practice Address - Fax:913-829-6197
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00184213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS09117011OtherBLUE CROSS BLUE SHIELD
KS074568OtherBLUE SHIELD TOPEKA
KSP00011186Medicare ID - Type UnspecifiedMEDICARE RAIL ROAD
KS09117011OtherBLUE CROSS BLUE SHIELD
KST42330Medicare UPIN