Healthcare Provider Details

I. General information

NPI: 1124154992
Provider Name (Legal Business Name): STEVE HAROLD HEGSTROM C.P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 W 103RD ST SUITE 300
OVERLAND PARK KS
66214-2642
US

IV. Provider business mailing address

5045 OUTLOOK RD
MISSION KS
66202-1842
US

V. Phone/Fax

Practice location:
  • Phone: 913-941-1910
  • Fax:
Mailing address:
  • Phone: 913-677-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number117642
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14-00052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: