Healthcare Provider Details

I. General information

NPI: 1831163005
Provider Name (Legal Business Name): STEVEN POPLAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 FARAON ST
SAINT JOSEPH MO
64506-3488
US

IV. Provider business mailing address

3906 OAKLAND AVE UNIT 8252
SAINT JOSEPH MO
64508-7515
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-6575
  • Fax: 816-271-6139
Mailing address:
  • Phone: 816-271-6575
  • Fax: 816-271-6139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2005030243
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0431648
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: