Basic Information
| Provider Information | |||||||||
| NPI: | 1750352282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAXMAN | ||||||||
| FirstName: | STEVE | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 823 SW MULVANE ST. | ||||||||
| Address2: | STE. 275 | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852704355 | ||||||||
| FaxNumber: | 7852704364 | ||||||||
| Practice Location | |||||||||
| Address1: | 823 SW MULVANE ST STE 275 | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852704355 | ||||||||
| FaxNumber: | 7852704364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 1009018482 | MO | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 04-22090 | KS | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | FW1497482 | 01 | DEA | OTHER |