Provider Demographics
NPI:1902898968
Name:GROTE, STEWART R (DO)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:R
Last Name:GROTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 1ST TER
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1704
Mailing Address - Country:US
Mailing Address - Phone:913-727-6000
Mailing Address - Fax:913-351-1346
Practice Address - Street 1:712 1ST TER
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1704
Practice Address - Country:US
Practice Address - Phone:913-727-6000
Practice Address - Fax:913-351-1346
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-22108207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13565015OtherBCBS KC
100543OtherBC KS
KS2456370802Medicaid
100543Medicare ID - Type Unspecified
KS2456370802Medicaid