Basic Information
| Provider Information | |||||||||
| NPI: | 1932190683 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RESNICK | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 46 | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674020046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3163004021 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1550 W CRAIG RD | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890320224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027773615 | ||||||||
| FaxNumber: | 7026420808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0530324 | KS | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | CL0025 | NV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OS16417 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 0530324 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS16417 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100456590Y | 05 | KS | MEDICAID | P00693496 | 01 | KS | RR | OTHER |