Healthcare Provider Details

I. General information

NPI: 1750333035
Provider Name (Legal Business Name): JOHN R HERTENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9051 N E 81ST TERR SUITE 100
KANSAS CITY MO
64158
US

IV. Provider business mailing address

9051 N E 81ST TERR SUITE 100
KANSAS CITY MO
64158
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-1170
  • Fax: 816-792-3877
Mailing address:
  • Phone: 816-792-1170
  • Fax: 816-792-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR7783
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: