Provider Demographics
NPI:1750349155
Name:GRUENEBAUM, STEVEN A (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:GRUENEBAUM
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 1:8550 MARSHALL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1505
Mailing Address - Country:US
Mailing Address - Phone:816-942-8200
Mailing Address - Fax:913-495-3760
Practice Address - Street 1:373 W 101ST TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4498
Practice Address - Country:US
Practice Address - Phone:816-942-8200
Practice Address - Fax:913-495-3760
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7C05207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00475774OtherRR MEDICARE
MOP00475778OtherRR MEDICARE
MOP00475778OtherRR MEDICARE
MOK67000003Medicare PIN
KSF206602Medicare PIN
KSC50584Medicare UPIN
KSK67A00001Medicare PIN
MOF200000BMedicare PIN
KSF200000Medicare PIN