Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 04-37161 | KS |
NPI | 1689832651 |
---|---|
Provider Name | Dr. Steven Matthew Hollenbeck |
First Address | Wichita, KS 67205-9363 |
Second Address | Wichita, KS 67205-9363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 21/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201099100A | (05) | KS |