Healthcare Provider Details

I. General information

NPI: 1083627525
Provider Name (Legal Business Name): CHARLES RICHARD VENNEMAN II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CARONDELET DR
KANSAS CITY MO
64114-4673
US

IV. Provider business mailing address

10310 STATE LINE RD STE A
LEAWOOD KS
66206-2695
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-2252
  • Fax: 816-943-4656
Mailing address:
  • Phone: 913-647-4101
  • Fax: 913-647-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR3N23
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: