Provider Demographics
NPI:1689644668
Name:PELOQUIN, STEVEN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:PELOQUIN
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 1:1133 COLLEGE AVE
Mailing Address - Street 2:STE F100
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2756
Mailing Address - Country:US
Mailing Address - Phone:785-320-6700
Mailing Address - Fax:785-320-6701
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:SUITE F100
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-320-6700
Practice Address - Fax:785-320-6701
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427267207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100307440BMedicaid
KS7423430001OtherDME PTAN
KS102044Medicare PIN
KS7423430001OtherDME PTAN
KS50086642Medicare PIN