Provider Demographics
NPI:1932172525
Name:STEVENS, PHILIP D (MD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:D
Last Name:STEVENS
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 1:5201 NEOSHO AVE
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1435
Mailing Address - Country:US
Mailing Address - Phone:913-384-0422
Mailing Address - Fax:
Practice Address - Street 1:5201 NEOSHO AVE
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-1435
Practice Address - Country:US
Practice Address - Phone:913-384-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8664207P00000X
KS0417932207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1932172525OtherBCBS
KS1932172525OtherBCBS
KSKA1398011Medicare PIN