Healthcare Provider Details

I. General information

NPI: 1962997759
Provider Name (Legal Business Name): CONNOR JOEL GRANTHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

4000 CAMBRIDGE ST # MS 3018
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6000
  • Fax: 913-588-9251
Mailing address:
  • Phone: 913-588-3974
  • Fax: 913-588-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number04-44634
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-44634
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: