Healthcare Provider Details

I. General information

NPI: 1376619635
Provider Name (Legal Business Name): GERHARD W CIBIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 J C NICHOLS PKWY 421
KANSAS CITY MO
64112-1617
US

IV. Provider business mailing address

4620 J C NICHOLS PKWY 421
KANSAS CITY MO
64112-1617
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-0306
  • Fax: 816-531-7166
Mailing address:
  • Phone: 816-561-0306
  • Fax: 816-531-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DENEANE THOMPSON
Title or Position: PRACTICE COORDINATOR
Credential:
Phone: 913-491-0765