MEDICARE: STEPHANIE RACHEL ELBERTS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	05-47436	KS

General Provider Information

NPI Number	:	1255968459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE RACHEL ELBERTS DO

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD # MS 2027
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8500
Country	:	US
Telephone Number	:	913-588-3974
Fax Number	:	913-588-6055

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD # MS 2027
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-2645
Country	:	US
Telephone Number	:	913-588-3974
Fax Number	:	913-588-6055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	06/28/2023

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