Individual
STEPHEN C. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19600 E 39TH ST S, INDEPENDENCE, MO 64057-2301
(913) 428-2900
(913) 428-2951
Mailing address
8717 W 110TH ST, SUITE 600, OVERLAND PARK, KS 66210-2144
(913) 428-2900
(913) 428-2951
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
04-21076
KS
207L00000X
Anesthesiology Physician
Primary
R5J54
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100192350C
—
KS
05
—
202168845
—
MO
Enumeration date
11/15/2005
Last updated
08/18/2014
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