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General NPI Number Information
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NPI Number | 1316969884
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Entity Type | Organization
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Legal Business Name | KANSAS CITY INTERNAL MEDICINE PA
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 12140 NALL AVE SUITE 100
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City | OVERLAND PARK
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State | KS
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Zip | 66209-2504
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Country | US
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Telephone | 913-451-8500
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Fax | 913-451-1754
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Provider Business Mailing Address
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Address Line | 12140 NALL AVE SUITE 100
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City | OVERLAND PARK
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State | KS
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Zip | 66209-2504
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Country | US
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Telephone | 913-451-8500
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Fax | 913-451-1754
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Authorized Official
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Title or Position | CEO
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Name | JEAN A HANSEN
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Credential | MBA, FACMPE
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Telephone | 913-319-7303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 103093
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 111706
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License Number State | MO
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