Provider Demographics
NPI:1770596512
Name:PASSMAN, STEVEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:PASSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1861 N ROCK RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4200
Mailing Address - Country:US
Mailing Address - Phone:316-612-1833
Mailing Address - Fax:316-612-2420
Practice Address - Street 1:1861 N ROCK RD
Practice Address - Street 2:SUITE 310
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-4200
Practice Address - Country:US
Practice Address - Phone:316-612-1833
Practice Address - Fax:316-612-2420
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20338207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102832OtherPREMIER BLUE
KS110898OtherBLUE CROSS BLUE SHIELD
KS412085867-A002OtherTRICARE
KSP00058828OtherRAILROAD MEDICARE
KS611580OtherFIRST GUARD
KS110898Medicare PIN
KS102832OtherPREMIER BLUE
KS611580OtherFIRST GUARD