Healthcare Provider Details

I. General information

NPI: 1518087162
Provider Name (Legal Business Name): KENNETH SPENGEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14425 COLLEGE BLVD STE 130
LENEXA KS
66215-2317
US

IV. Provider business mailing address

14425 COLLEGE BLVD STE 130
LENEXA KS
66215-2317
US

V. Phone/Fax

Practice location:
  • Phone: 913-396-8509
  • Fax: 913-495-9743
Mailing address:
  • Phone: 913-396-8509
  • Fax: 913-495-9743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number332697
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number6080
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: