Healthcare Provider Details

I. General information

NPI: 1982099123
Provider Name (Legal Business Name): KEVIN MUNGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2015
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE ADAMS DAIRY PKWY
BLUE SPRINGS MO
64014-5493
US

IV. Provider business mailing address

600 NE ADAMS DAIRY PKWY
BLUE SPRINGS MO
64014-5493
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-6100
  • Fax: 816-347-4695
Mailing address:
  • Phone: 816-347-4600
  • Fax: 816-347-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2018007808
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018007808
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: