Healthcare Provider Details

I. General information

NPI: 1235203308
Provider Name (Legal Business Name): DAVID EDWARD STERNBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 SW MARKET ST
LEES SUMMIT MO
64063-3918
US

IV. Provider business mailing address

4201 W 110TH ST
LEAWOOD KS
66211-1422
US

V. Phone/Fax

Practice location:
  • Phone: 913-209-9495
  • Fax: 913-498-0523
Mailing address:
  • Phone: 913-498-0522
  • Fax: 913-498-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberR1P78
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR1P78
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA08170700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number04-22290
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD431788
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number25MA08170700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: