MEDICARE: DR. SAMUEL KUYKENDALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	04-35782	KS
2	208800000X	Urology Physician	2012017449	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01229653	OTHER	KS	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47807015	OTHER		BCBS KC

General Provider Information

NPI Number	:	1194948778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL KUYKENDALL M.D.

Provider Business Mailing Address
First Line	:	4321 WASHINGTON ST STE 5300
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-5931
Country	:	US
Telephone Number	:	816-531-1234
Fax Number	:	816-531-0737

Provider Business Practice Location Address
First Line	:	4321 WASHINGTON ST STE 5300
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-5931
Country	:	US
Telephone Number	:	816-531-1234
Fax Number	:	816-531-0737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	01/15/2021

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Directions to “ DR. SAMUEL KUYKENDALL M.D.” Practice Location

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