Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 94-09283 | KS |
N | 111NI0900X | Internist | 94-09283 | KS |
Y | 207W00000X | Ophthalmologist | 94-09283 | KS |
NPI | 1003345786 |
---|---|
Provider Name | Christopher Stefonowicz |
First Address | Kansas City, KS 66160-8500 |
Second Address | Prairie Village, KS 66208-3444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2017 |
Last Update Date | 23/07/2020 |