Healthcare Provider Details

I. General information

NPI: 1245333137
Provider Name (Legal Business Name): THELDA M KESTENBAUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD DEPT OF INTERNAL MEDICINE
KANSAS CITY KS
66160
US

IV. Provider business mailing address

3901 RAINBOW BLVD. MS 2025
KANSAS CITY KS
66160
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6000
  • Fax:
Mailing address:
  • Phone: 913-588-3840
  • Fax: 913-588-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number04-17264
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: