Healthcare Provider Details

I. General information

NPI: 1689613093
Provider Name (Legal Business Name): KENNETH KOONTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CARONDELET DR
KANSAS CITY MO
64114-4673
US

IV. Provider business mailing address

8000 W 110TH ST STE 150
OVERLAND PARK KS
66210-2382
US

V. Phone/Fax

Practice location:
  • Phone: 913-599-6777
  • Fax: 913-599-3955
Mailing address:
  • Phone: 913-599-6777
  • Fax: 913-599-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4272-320
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR3M47
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: