Provider Demographics
NPI:1467463356
Name:GOLLUB, STEVEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:B
Last Name:GOLLUB
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 1:4000 AMBRIDGE STREET STE G600
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-9600
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE ST STE G600
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-2937
Practice Address - Country:US
Practice Address - Phone:913-588-9600
Practice Address - Fax:913-588-9770
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1C60207RC0000X
KS04-18387207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201967007Medicaid
10804029OtherBCBS KC
KS100200070CMedicaid
KS100200070DMedicaid
KS100861OtherBCBS KS
MO201967007Medicaid
MOP00162351Medicare PIN
MO038A00010Medicare PIN
KS100861Medicare PIN
KS100861OtherBCBS KS
10804029OtherBCBS KC
KSP00154438Medicare PIN
MO0386610EMedicare PIN
KS0386610BMedicare PIN
MO038E00015Medicare PIN
KS0386610BMedicare PIN
KSP00154438Medicare PIN