Healthcare Provider Details

I. General information

NPI: 1588941900
Provider Name (Legal Business Name): JOANNE LOETHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 06/16/2023
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-4862
  • Fax: 816-404-4261
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2019012556
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019012556
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2016019920
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019012556
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: