Provider Demographics
NPI:1215916143
Name:SEGRAVES, STEVEN DEANE (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DEANE
Last Name:SEGRAVES
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 1:8900 STATE LINE RD
Mailing Address - Street 2:STE 380
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206
Mailing Address - Country:US
Mailing Address - Phone:913-385-7252
Mailing Address - Fax:913-385-2412
Practice Address - Street 1:8900 STATE LINE RD
Practice Address - Street 2:STE 380
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206
Practice Address - Country:US
Practice Address - Phone:913-385-7252
Practice Address - Fax:913-385-2412
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04227322084P0800X, 2084P0805X
MOR3K752084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
15565019OtherBCBS OF KC
A911400BMedicare ID - Type Unspecified
15565019OtherBCBS OF KC
057597Medicare ID - Type Unspecified
E65678Medicare UPIN
A911400AMedicare ID - Type Unspecified