Provider Demographics
NPI: | 1558398966 |
---|---|
Name: | TAYLOR, STEVEN L (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | STEVEN |
Middle Name: | L |
Last Name: | TAYLOR |
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: | PO BOX 645 |
Mailing Address - Street 2: | |
Mailing Address - City: | WICHITA |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 67201-0645 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 316-689-5050 |
Mailing Address - Fax: | 316-689-6192 |
Practice Address - Street 1: | 3600 E HARRY ST |
Practice Address - Street 2: | |
Practice Address - City: | WICHITA |
Practice Address - State: | KS |
Practice Address - Zip Code: | 67218-3713 |
Practice Address - Country: | US |
Practice Address - Phone: | 316-689-5050 |
Practice Address - Fax: | 316-689-6192 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-28 |
Last Update Date: | 2014-05-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KS | 17943 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KS | 100141050C | Medicaid | |
KS | 1285 | Other | PHS |
KS | 200158 | Other | HPK |
KS | 12149492 | Other | MULTIPLAN |
KS | 003672 | Other | BCBS |
KS | 16928 | Other | COVENTRY |
KS | 200158 | Other | HPK |
KS | 003672 | Medicare ID - Type Unspecified |