Healthcare Provider Details

I. General information

NPI: 1053316612
Provider Name (Legal Business Name): LOUISE M KAINE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 W 75TH ST STE 300
SHAWNEE MISSION KS
66204-4001
US

IV. Provider business mailing address

5555 W 58TH ST
MISSION KS
66202-2722
US

V. Phone/Fax

Practice location:
  • Phone: 913-722-4240
  • Fax: 913-722-2435
Mailing address:
  • Phone: 913-676-6120
  • Fax: 913-432-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0526698
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: