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General NPI Number Information
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NPI Number | 1215432257
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Entity Type | Individual
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Provider Name | STEPHEN LONGSHORE AMBROSE MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 7400 STATE LINE RD
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-3444
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Country | US
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Telephone | 913-588-6600
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Fax | 913-588-6655
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Provider Business Mailing Address
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Address Line | 7400 STATE LINE RD
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-3444
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Country | US
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Telephone | 913-588-0831
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Fax | 913-588-6655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 91372
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | 04-47757
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License Number State | KS
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