MEDICARE: DAMIEN R STEVENS M.D.

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2003023604	MO
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	0430396	KS
3	207RP1001X	Pulmonary Disease Physician	2003023604	MO
4	207RP1001X	Pulmonary Disease Physician	0430396	KS
5	207RS0012X	Sleep Medicine (Internal Medicine) Physician	04-30396	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104188	OTHER	KS	BCBS KS
2	10001668700	OTHER		COMMUNITY HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	21782034	OTHER	MO	BCBS KC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548262322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMIEN R STEVENS M.D.

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MAIL STOP 3007
City	:	KANSAS CITY
State	:	KS
Zip	:	66103-2937
Country	:	US
Telephone Number	:	913-588-6045
Fax Number	:	913-588-4098

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MAIL STOP 3007
City	:	KANSAS CITY
State	:	KS
Zip	:	66103-2937
Country	:	US
Telephone Number	:	913-588-6045
Fax Number	:	913-588-4098

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	08/24/2011

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Directions to “ DAMIEN R STEVENS M.D.” Practice Location

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