Healthcare Provider Details

I. General information

NPI: 1255377958
Provider Name (Legal Business Name): KAREN E NEUBAUER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 GRANADA LN
LEAWOOD KS
66211-1453
US

IV. Provider business mailing address

11550 GRANADA LN
LEAWOOD KS
66211-1453
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-7546
  • Fax: 913-663-2422
Mailing address:
  • Phone: 913-451-7546
  • Fax: 913-663-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2004016560
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number530781
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: