Healthcare Provider Details

I. General information

NPI: 1568158202
Provider Name (Legal Business Name): KANSAS CITY VASCULAR INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 COLLEGE BLVD
LEAWOOD KS
66211-1621
US

IV. Provider business mailing address

5320 COLLEGE BLVD
LEAWOOD KS
66211-1621
US

V. Phone/Fax

Practice location:
  • Phone: 913-279-0233
  • Fax: 830-632-6568
Mailing address:
  • Phone: 913-279-0233
  • Fax: 830-632-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUAN CARLOS CORREA
Title or Position: MD/OWNER
Credential: MD
Phone: 314-698-8894