Provider Demographics
NPI:1063855898
Name:KULOW, BENJAMIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:J
Last Name:KULOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MS 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-599-9499
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:5844 NW BARRY RD STE 120
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1483
Practice Address - Country:US
Practice Address - Phone:816-472-9595
Practice Address - Fax:816-472-1132
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-42290208C00000X
MO2018015473208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery