Healthcare Provider Details

I. General information

NPI: 1083051908
Provider Name (Legal Business Name): CHARLES PAUL WILLNAUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2013
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7199 W 98TH TER STE 110
OVERLAND PARK KS
66212-6162
US

IV. Provider business mailing address

7199 W 98TH TER STE 110
OVERLAND PARK KS
66212-6162
US

V. Phone/Fax

Practice location:
  • Phone: 913-948-7652
  • Fax: 913-273-2474
Mailing address:
  • Phone: 913-948-7652
  • Fax: 913-273-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-40040
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: