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General NPI Number Information
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NPI Number | 1407016439
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Entity Type | Individual
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Provider Name | CASEY PATRICK HERTZENBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 9119 W 74TH ST STE 350
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204-2268
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Country | US
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Telephone | 913-632-9418
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Fax | 913-632-9447
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Provider Business Mailing Address
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Address Line | 9119 W 74TH ST STE 350
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204-2268
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Country | US
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Telephone | 913-632-9418
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Fax | 913-632-9447
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 94-07038
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 04-36350
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License Number State | KS
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