Provider Demographics
NPI:1457507659
Name:PRO, STEPHAN L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:L
Last Name:PRO
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 1:6265 ROCK CHALK DR
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-843-9125
Mailing Address - Fax:785-843-3176
Practice Address - Street 1:6265 ROCK CHALK DR
Practice Address - Street 2:SUITE 1500
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28399207X00000X
KS04-35024207X00000X
KS0435024207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery