MEDICARE: DR. CHRISTINE M BOUTWELL 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	2084N0400X	Neurology Physician	04-28664	KS
2	2084N0400X	Neurology Physician	103475	MO

General Provider Information

NPI Number	:	1922046317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE M BOUTWELL M.D.

Provider Business Mailing Address
First Line	:	901 E 104TH ST
Second Line	:	MAILSTOP 400
City	:	KANSAS CITY
State	:	MO
Zip	:	64131
Country	:	US
Telephone Number	:	816-599-9499
Fax Number	:	816-932-9670

Provider Business Practice Location Address
First Line	:	4400 BROADWAY
Second Line	:	SUITE 520
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3342
Country	:	US
Telephone Number	:	816-531-4080
Fax Number	:	816-531-0281

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	11/15/2017

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