=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831163005
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN POPLAW MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2006
-----------------------------------------------------
Last Update Date | 02/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5325 FARAON ST
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64506-3488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-271-6575
-----------------------------------------------------
Fax | 816-271-6139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3906 OAKLAND AVE UNIT 8252
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64508-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-271-6575
-----------------------------------------------------
Fax | 816-271-6139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 2005030243
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 0431648
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------