Healthcare Provider Details

I. General information

NPI: 1992042089
Provider Name (Legal Business Name): KENNETH A. NEWMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
SHAWNEE MISSION KS
66204-4004
US

IV. Provider business mailing address

PO BOX 26207
OVERLAND PARK KS
66225-6207
US

V. Phone/Fax

Practice location:
  • Phone: 913-642-4900
  • Fax: 913-381-0979
Mailing address:
  • Phone: 913-642-4900
  • Fax: 913-381-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number0426120
License Number StateKS

VIII. Authorized Official

Name: KENNETH A. NEWMAN
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 913-642-4900