MEDICARE: DR. STEPHEN URBAN STECHSCHULTE MD

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	207W00000X	Ophthalmology Physician	2000165901	MO
2	207W00000X	Ophthalmology Physician	0428816	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180041408	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1568455830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN URBAN STECHSCHULTE MD

Provider Business Mailing Address
First Line	:	9009 ROE AVE
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207-2202
Country	:	US
Telephone Number	:	913-385-9009
Fax Number	:	913-385-3005

Provider Business Practice Location Address
First Line	:	9009 ROE AVE
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207-2202
Country	:	US
Telephone Number	:	913-385-9009
Fax Number	:	913-385-3005

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/03/2011

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