Healthcare Provider Details

I. General information

NPI: 1366484891
Provider Name (Legal Business Name): KEITH A SALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MS 3010
KANSAS CITY KS
66160-0001
US

IV. Provider business mailing address

PO BOX 411851
KANSAS CITY MO
64141-1851
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6701
  • Fax: 913-588-6708
Mailing address:
  • Phone: 913-588-6701
  • Fax: 913-588-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number04-30013
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number04-30013
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: