Provider Demographics
NPI:1659361632
Name:DONNENWERTH, STEVEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:DONNENWERTH
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 308
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124
Mailing Address - Country:US
Mailing Address - Phone:620-672-7422
Mailing Address - Fax:620-508-6476
Practice Address - Street 1:203 WATSON
Practice Address - Street 2:SUITE 200
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124
Practice Address - Country:US
Practice Address - Phone:620-672-7422
Practice Address - Fax:620-508-6476
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35220207P00000X
KS04-32339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200426870AMedicaid
MNH89552Medicare UPIN
H89552Medicare UPIN