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NPI Code Detail

MEDICARE: DR. BENJAMIN PETELIN DO

MEDICARE: DR. BENJAMIN PETELIN DO
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
1207R00000XInternal Medicine Physician0536409KS
2207R00000XInternal Medicine Physician2016028966MO

General Provider Information

NPI Number : 1386955334
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN PETELIN DO
Provider Business Mailing Address
First Line : 901 E. 104TH ST
Second Line : MAILSTOP 400N
City : KANSAS CITY
State : MO
Zip : 64131
Country : US
Telephone Number : 816-502-7104
Fax Number : 816-932-9670
Provider Business Practice Location Address
First Line : 4321 WASHINGTON ST STE 3000
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-5928
Country : US
Telephone Number : 816-932-3100
Fax Number : 816-932-6871
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2010
Last Update Date : 01/29/2018

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Directions to “ DR. BENJAMIN PETELIN DO” Practice Location

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