Healthcare Provider Details

I. General information

NPI: 1457312787
Provider Name (Legal Business Name): STEVEN B GEDULDIG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W 151ST ST
OLATHE KS
66061-5300
US

IV. Provider business mailing address

9119 W 74TH ST
OVERLAND PARK KS
66204-2229
US

V. Phone/Fax

Practice location:
  • Phone: 913-829-6800
  • Fax: 913-829-6197
Mailing address:
  • Phone: 913-677-3600
  • Fax: 913-432-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number12-00184
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: