MEDICARE: DR. GERALD KEITH JANTZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	R1D18	MO
2	207R00000X	Internal Medicine Physician	04-25021	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659362648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD KEITH JANTZ M.D.

Provider Business Mailing Address
First Line	:	12504 CATALINA ST.
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209
Country	:	US
Telephone Number	:	816-363-4100
Fax Number	:	816-363-4393

Provider Business Practice Location Address
First Line	:	12504 CATALINA ST.
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209
Country	:	US
Telephone Number	:	816-210-6625
Fax Number	:	816-262-4393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	02/25/2016

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