Provider Demographics
NPI:1043440944
Name:ENGELMAN, KALISTA TROMBLEY (DO)
Entity Type:Individual
Prefix:
First Name:KALISTA
Middle Name:TROMBLEY
Last Name:ENGELMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KALISTA
Other - Middle Name:JEAN
Other - Last Name:TROMBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4440 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3315
Mailing Address - Country:US
Mailing Address - Phone:816-531-0930
Mailing Address - Fax:816-753-2671
Practice Address - Street 1:4440 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3315
Practice Address - Country:US
Practice Address - Phone:816-531-0930
Practice Address - Fax:816-753-2671
Is Sole Proprietor?:No
Enumeration Date:2009-07-26
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-36624207RR0500X, 207RR0500X
MO2015001548207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4663013Medicare PIN
MI0M33350Medicare PIN