Healthcare Provider Details

I. General information

NPI: 1477549327
Provider Name (Legal Business Name): KEVIN F KNOP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

PO BOX 804408
KANSAS CITY MO
64180-0001
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-7200
  • Fax:
Mailing address:
  • Phone: 913-647-4100
  • Fax: 913-647-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR5G38
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: