Provider Demographics
NPI:1427090406
Name:SALANSKI, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SALANSKI
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 1:282 SE SUMPTER CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-3669
Mailing Address - Country:US
Mailing Address - Phone:816-536-3451
Mailing Address - Fax:
Practice Address - Street 1:282 SE SUMPTER CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-3669
Practice Address - Country:US
Practice Address - Phone:816-536-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202648325Medicaid
KS100642510BMedicaid
MO202648317Medicaid
MOP00073773Medicare ID - Type UnspecifiedRAILROAD MEDICARE -GOPPER
MO202648317Medicaid
MO202648325Medicaid