Provider Demographics
NPI:1043416985
Name:KIEWIET, NATHAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JOHN
Last Name:KIEWIET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19550 E. 39TH ST
Mailing Address - Street 2:STE 410
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057
Mailing Address - Country:US
Mailing Address - Phone:816-303-2400
Mailing Address - Fax:816-303-2484
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 600
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3274
Practice Address - Country:US
Practice Address - Phone:816-561-3003
Practice Address - Fax:816-889-1584
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013009354207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013009354OtherMISSOURI LICENSE