Healthcare Provider Details

I. General information

NPI: 1548262322
Provider Name (Legal Business Name): DAMIEN R STEVENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MAIL STOP 3007
KANSAS CITY KS
66103-2937
US

IV. Provider business mailing address

3901 RAINBOW BLVD MAIL STOP 3007
KANSAS CITY KS
66103-2937
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6045
  • Fax: 913-588-4098
Mailing address:
  • Phone: 913-588-6045
  • Fax: 913-588-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2003023604
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0430396
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2003023604
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0430396
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number04-30396
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: