Healthcare Provider Details

I. General information

NPI: 1871686279
Provider Name (Legal Business Name): LEANNE DETAR NEWBERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15604 PINEHURST DR SUITE 2
BASEHOR KS
66007-8233
US

IV. Provider business mailing address

1000 CARONDELET DR PROVIDER ENROLLMENT/MED STAFF OFC
KANSAS CITY MO
64114
US

V. Phone/Fax

Practice location:
  • Phone: 913-728-2200
  • Fax: 913-728-2230
Mailing address:
  • Phone: 816-943-5744
  • Fax: 816-943-2767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0422698
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: