MEDICARE: DR. KELLY L RHODES-STARK MD

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	2085R0001X	Radiation Oncology Physician	104876	MO
2	2085R0001X	Radiation Oncology Physician	04-24606	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	:	1871556423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY L RHODES-STARK MD

Provider Business Mailing Address
First Line	:	6601 WINCHESTER AVE
Second Line	:	SUITE 230
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-4677
Country	:	US
Telephone Number	:	816-313-2677
Fax Number	:	816-313-6000

Provider Business Practice Location Address
First Line	:	20375 W 151ST ST
Second Line	:	SUITE 180
City	:	OLATHE
State	:	KS
Zip	:	66061-5306
Country	:	US
Telephone Number	:	913-768-7200
Fax Number	:	913-768-9714

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	01/09/2013

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Directions to “ DR. KELLY L RHODES-STARK MD” Practice Location

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