Healthcare Provider Details

I. General information

NPI: 1942354246
Provider Name (Legal Business Name): STEVEN FRANK ELLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5370 COLLEGE BLVD SUITE 100
OVERLAND PARK KS
66211-1891
US

IV. Provider business mailing address

5370 COLLEGE BLVD SUITE 100
OVERLAND PARK KS
66211-1891
US

V. Phone/Fax

Practice location:
  • Phone: 913-599-4800
  • Fax: 913-599-2992
Mailing address:
  • Phone: 913-599-4800
  • Fax: 913-599-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD110162
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number04-26174
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: