Provider Demographics
NPI:1144201914
Name:SUTTMOELLER, KEVIN E (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:SUTTMOELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4673
Mailing Address - Country:US
Mailing Address - Phone:816-943-5744
Mailing Address - Fax:816-943-5762
Practice Address - Street 1:1004 CARONDELET DR STE 300B
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4801
Practice Address - Country:US
Practice Address - Phone:816-943-4700
Practice Address - Fax:816-941-4504
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-41936207R00000X
MO101192207RB0002X, 207R00000X
KS05-4196207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243615317Medicaid
MOF35626Medicare UPIN
MOP00445866Medicare PIN
MO311381444Medicare PIN
MO311385236Medicare PIN
MO243615317Medicaid