Provider Demographics
NPI:1477560803
Name:THORNTON, STEPHEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:THORNTON
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 1:12784 ABERDEEN CT
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2454
Mailing Address - Country:US
Mailing Address - Phone:599-940-0421
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE STREET 4045B DELP
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-914-6088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005011352207P00000X, 207PT0002X
CAA80775207P00000X
KS04-31362207PT0002X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
481202402OtherPSKU TAX ID
KS200366630AMedicaid
7990888OtherAETNA PSKU
MO202299129Medicaid
7990888OtherAETNA PSKU
KSK40E152Medicare PIN
I26820Medicare UPIN
481202402OtherPSKU TAX ID
MO202299129Medicaid