Healthcare Provider Details

I. General information

NPI: 1548605223
Provider Name (Legal Business Name): BRENT KIDD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-1900
US

IV. Provider business mailing address

UNIVERSITY OF KANSAS MEDICAL CENTER DEPARTMENT OF ANES. 3901 RAINBOW BOULEVARD MAILSTOP 1034
KANSAS CITY KS
66160
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-7415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number04-41097
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: