Provider Demographics
NPI:1114936986
Name:GENTON, RANDALL E (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:E
Last Name:GENTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CAMBRIDGE ST STE G600
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-9600
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE ST STE G600
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-9600
Practice Address - Fax:913-588-9700
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36874207RC0000X, 207RI0011X
KS04-23109207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16237010OtherBCBS KC
KS100208890AMedicaid
KS100208890BMedicaid
MO202430310Medicaid
MO0381527AMedicare PIN
KS051561Medicare PIN
KS100208890AMedicaid
KS0381527BMedicare PIN
KS110330015Medicare PIN
MO202430310Medicaid
MO202430310Medicaid
KS060062380Medicare PIN
KS051561Medicare PIN