Healthcare Provider Details

I. General information

NPI: 1649333741
Provider Name (Legal Business Name): SHANNON MARIE KRAFT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1917 W 48TH ST
WESTWOOD KS
66205-1902
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6739
  • Fax: 913-588-4676
Mailing address:
  • Phone: 913-499-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9406641
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: