Provider Demographics
NPI:1932136959
Name:WILES, STEPHEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:WILES
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 1:211 NE 54TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4337
Mailing Address - Country:US
Mailing Address - Phone:816-455-2020
Mailing Address - Fax:816-459-5690
Practice Address - Street 1:211 NE 54TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4362
Practice Address - Country:US
Practice Address - Phone:816-455-2020
Practice Address - Fax:816-459-5690
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1P52207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203420591Medicaid
MOE75404Medicare UPIN
MO6252740001Medicare NSC
MOM772562Medicare PIN