Provider Demographics
NPI:1336249721
Name:LARSEN, STEVEN BRADLEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BRADLEY
Last Name:LARSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 VINE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601
Mailing Address - Country:US
Mailing Address - Phone:785-625-7117
Mailing Address - Fax:785-650-0040
Practice Address - Street 1:2707 VINE
Practice Address - Street 2:SUITE 6
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-625-7117
Practice Address - Fax:785-650-0040
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12229213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6779Medicare ID - Type Unspecified
T43863Medicare UPIN