Healthcare Provider Details

I. General information

NPI: 1205836251
Provider Name (Legal Business Name): STEPHEN J WASSINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 WASHINGTON ST STE 5000
KANSAS CITY MO
64111
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-1785
  • Fax: 816-932-1382
Mailing address:
  • Phone: 816-599-9499
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2018002920
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-41055
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number04-41055
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number2018002920
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: