Basic Information
| Provider Information | |||||||||
| NPI: | 1609875426 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBERHELMAN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3460 N RIDGE RD STE 160 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672051223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167221333 | ||||||||
| FaxNumber: | 3167223058 | ||||||||
| Practice Location | |||||||||
| Address1: | 3460 N RIDGE RD STE 160 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672051223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167221333 | ||||||||
| FaxNumber: | 3167223058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 05-29427 | KS | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100401780B | 05 | KS | MEDICAID | 100401780A | 05 | KS | MEDICAID |