Healthcare Provider Details

I. General information

NPI: 1649659459
Provider Name (Legal Business Name): TRAVIS KAUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

8005 W 110TH ST STE 214
OVERLAND PARK KS
66210-2619
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-4862
  • Fax: 816-404-9480
Mailing address:
  • Phone: 913-599-6777
  • Fax: 913-599-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2015019332
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2943-321
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number05-44934
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: