Provider Demographics
NPI:1932164373
Name:GRINDEL, STEPHEN JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:GRINDEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 E. 21ST STREET N.
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1078
Mailing Address - Country:US
Mailing Address - Phone:316-684-2851
Mailing Address - Fax:316-683-5239
Practice Address - Street 1:7111 E. 21ST STREET N.
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1078
Practice Address - Country:US
Practice Address - Phone:316-684-2851
Practice Address - Fax:316-683-5239
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-21958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100233010DMedicaid
E50021Medicare UPIN
KS110718002Medicare PIN
KS100233010 AMedicaid
045437Medicare PIN