Healthcare Provider Details

I. General information

NPI: 1669770434
Provider Name (Legal Business Name): SPORTS MED PLUS OF LEES SUMMIT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 NE MCBAIN DR SUITE B
LEES SUMMIT MO
64064-7880
US

IV. Provider business mailing address

2741 NE MCBAIN DR SUITE B
LEES SUMMIT MO
64064-7880
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-2600
  • Fax: 816-554-2603
Mailing address:
  • Phone: 816-554-2600
  • Fax: 816-554-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLA S KUTCH
Title or Position: CO OWNER
Credential: DO
Phone: 816-554-2600