Provider Demographics
NPI:1760495402
Name:SMITH, STEPHEN DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DALE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:UNIVERSITY OF KANSAS MEDICAL CENTER
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6340
Mailing Address - Fax:913-588-2245
Practice Address - Street 1:2330 SHAWNEE MISSION PARKWAY
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205
Practice Address - Country:US
Practice Address - Phone:913-588-6340
Practice Address - Fax:913-588-2245
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-03-27
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Provider Licenses
StateLicense IDTaxonomies
IL0360795232080P0207X
KS04-173612080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100287090BMedicaid
IL036079523Medicaid