MEDICARE: DR. KENNETH CRAIG PLACE 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	207W00000X	Ophthalmology Physician	04-17640	KS
2	207W00000X	Ophthalmology Physician	35062	MO
3	207W00000X	Ophthalmology Physician	4301047588	MI

General Provider Information

NPI Number	:	1881621209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH CRAIG PLACE M.D.

Provider Business Mailing Address
First Line	:	9009 ROE AVE
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207-2202
Country	:	US
Telephone Number	:	913-385-9009
Fax Number	:	913-385-3005

Provider Business Practice Location Address
First Line	:	9009 ROE AVE
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207-2202
Country	:	US
Telephone Number	:	913-385-9009
Fax Number	:	913-385-3005

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	01/06/2011

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