Provider Demographics
NPI:1669554176
Name:THIES, STEPHEN PATRICK (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PATRICK
Last Name:THIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:913 SHEIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-9514
Mailing Address - Country:US
Mailing Address - Phone:913-322-7222
Mailing Address - Fax:913-322-7284
Practice Address - Street 1:913 SHEIDLEY AVE
Practice Address - Street 2:
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-9514
Practice Address - Country:US
Practice Address - Phone:913-322-7222
Practice Address - Fax:913-322-7284
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002008186207Q00000X
KS0432505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO002013491Medicare ID - Type UnspecifiedCPIN MEDICARE PART B
MOH64232Medicare UPIN