Healthcare Provider Details

I. General information

NPI: 1356736136
Provider Name (Legal Business Name): KYLE CHRISTOPHER WERTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 CORPORATE AVE STE 342
LENEXA KS
66219-1374
US

IV. Provider business mailing address

11300 CORPORATE AVE STE 342
LENEXA KS
66219-1374
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6111
  • Fax:
Mailing address:
  • Phone: 913-588-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number73023
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number33367
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13525A
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number73023-20
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number04-42212
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: