Provider Demographics
NPI:1366435919
Name:HULL, STEVEN GLEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:GLEN
Last Name:HULL
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 1:3470 NE RALPH POWELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2336
Mailing Address - Country:US
Mailing Address - Phone:913-498-3003
Mailing Address - Fax:913-341-5958
Practice Address - Street 1:3470 NE RALPH POWELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2336
Practice Address - Country:US
Practice Address - Phone:913-498-3003
Practice Address - Fax:913-341-5958
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23365207RP1001X
MO103504207RS0012X
KS0423365207RS0012X
IA36965207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0004181Medicare ID - Type Unspecified
MOMA1666001Medicare PIN
KSKA1365001Medicare PIN
IAIB1363001Medicare PIN
IAIB1362001Medicare PIN
KSE24563Medicare UPIN