Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 100227 | MO |
Y | 207Q00000X | Family Doctor | 100227 | MO |
NPI | 1104821818 |
---|---|
Provider Name | Dr. Steven Franklin Charochak |
First Address | Kansas City, MO 64114-4673 |
Second Address | Kansas City, MO 64114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 17/01/2022 |