Healthcare Provider Details

I. General information

NPI: 1497432918
Provider Name (Legal Business Name): PAUL BLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

3901 RAINBOW BLVD MAILSTOP 4032
KANSAS CITY KS
66160
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1847
  • Fax:
Mailing address:
  • Phone: 913-588-1847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number94-12944
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: