Healthcare Provider Details

I. General information

NPI: 1235299900
Provider Name (Legal Business Name): DANIEL KENNETH BERRY D.O., M.S.,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LOCUST STREET, ROOM 350 ACE300
KANSAS CITY MO
64106-9721
US

IV. Provider business mailing address

10821 S WHITETAIL LN
OLATHE KS
66061-9395
US

V. Phone/Fax

Practice location:
  • Phone: 816-329-3250
  • Fax: 816-329-3266
Mailing address:
  • Phone: 913-254-8532
  • Fax: 913-254-8539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2448
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB05854600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number05-35629
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number2448
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number25MB05854600
License Number StateNJ
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-35629
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: