Healthcare Provider Details

I. General information

NPI: 1841462314
Provider Name (Legal Business Name): MIDWEST DOCTORS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S SUITE 419
INDEPENDENCE MO
64057-2303
US

IV. Provider business mailing address

19550 E 39TH ST S SUITE 419
INDEPENDENCE MO
64057-2303
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-8200
  • Fax: 816-795-7735
Mailing address:
  • Phone: 816-795-8200
  • Fax: 816-795-7735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK J KUENY
Title or Position: VICE PRESIDENT
Credential:
Phone: 816-508-4090