Provider Demographics
NPI:1457429524
Name:RETTINGER, STEVEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:RETTINGER
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 1:7255 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-3043
Mailing Address - Country:US
Mailing Address - Phone:913-339-4400
Mailing Address - Fax:913-399-4410
Practice Address - Street 1:7255 RENNER RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-3043
Practice Address - Country:US
Practice Address - Phone:913-399-4400
Practice Address - Fax:913-399-4410
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102648207Q00000X
KS0424605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100183860BMedicaid
C489015Medicare ID - Type Unspecified
KS100183860BMedicaid