Provider Demographics
NPI:1932139466
Name:SAMUELSON, STEPHEN DARYL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DARYL
Last Name:SAMUELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8300 COLLEGE BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2814
Mailing Address - Country:US
Mailing Address - Phone:913-338-0400
Mailing Address - Fax:913-338-0428
Practice Address - Street 1:8300 COLLEGE BLVD STE 320
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2814
Practice Address - Country:US
Practice Address - Phone:913-338-0400
Practice Address - Fax:913-338-0428
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1128772084P0800X
KS04258382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO401713OtherBC&BS OF KC