Healthcare Provider Details

I. General information

NPI: 1649273541
Provider Name (Legal Business Name): FESTUS J KREBS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

IV. Provider business mailing address

296 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-4828
  • Fax: 816-524-4888
Mailing address:
  • Phone: 816-524-4828
  • Fax: 816-524-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR4E33
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: