Provider Demographics
NPI:1932190683
Name:RESNICK, STEPHEN A (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:RESNICK
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:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0046
Mailing Address - Country:US
Mailing Address - Phone:316-300-4021
Mailing Address - Fax:
Practice Address - Street 1:1550 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0224
Practice Address - Country:US
Practice Address - Phone:702-777-3615
Practice Address - Fax:702-642-0808
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0530324207P00000X, 207Q00000X
NVCL0025207P00000X
FLOS16417207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100456590YMedicaid
KSP00693496OtherRR
KSP00693496OtherRR