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General NPI Number Information
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NPI Number | 1376938423
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Entity Type | Individual
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Provider Name | BRIAN MICHAEL PENMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2015
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 4401 WORNALL RD
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City | KANSAS CITY
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State | MO
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Zip | 64111-3220
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Country | US
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Telephone | 816-932-2107
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Fax |
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Provider Business Mailing Address
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Address Line | 901 E 104TH STREET MAILSTOP 400S
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City | KANSAS CITY
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State | MO
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Zip | 64131
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Country | US
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Telephone | 816-502-7117
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Fax | 816-932-9670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2019024522
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License Number State | MO
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