Healthcare Provider Details

I. General information

NPI: 1538201702
Provider Name (Legal Business Name): GILLIAN SYLVIA STEPHENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MS 4010
KANSAS CITY KS
66160-0001
US

IV. Provider business mailing address

1406 N 79TH ST
KANSAS CITY KS
66112-2185
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1902
  • Fax:
Mailing address:
  • Phone: 913-299-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-29045
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: