Provider Demographics
NPI:1518923580
Name:HENSON, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:HENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 N WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2729
Mailing Address - Country:US
Mailing Address - Phone:316-858-2610
Mailing Address - Fax:316-858-2793
Practice Address - Street 1:2610 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2729
Practice Address - Country:US
Practice Address - Phone:316-858-2610
Practice Address - Fax:316-858-2793
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23263207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00606970OtherPALMETTO (RRMC)
KS100128240CMedicaid
KS930112904OtherRAILROAD MEDICARE
KS100980OtherBLUE CROSS BLUE SHIELD
KS100128240BMedicaid
KS640223OtherFIRST GUARD
KS100122880BMedicaid
KS100122880JMedicaid
KS100128240CMedicaid
KS004052023Medicare PIN
KSKA1872004Medicare PIN
KSP00606970OtherPALMETTO (RRMC)
KSE57653Medicare UPIN
KS100122880JMedicaid
KSKA1092002Medicare PIN