Provider Demographics
NPI:1164528626
Name:KANSAS CITY KIDNEY CONSULTANTS, PA
Entity Type:Organization
Organization Name:KANSAS CITY KIDNEY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUSTIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-531-0552
Mailing Address - Street 1:4320 WORNALL RD STE 208
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5964
Mailing Address - Country:US
Mailing Address - Phone:816-531-0552
Mailing Address - Fax:816-756-2503
Practice Address - Street 1:4320 WORNALL RD STE 208
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5964
Practice Address - Country:US
Practice Address - Phone:816-531-0552
Practice Address - Fax:816-756-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2022-05-06
Deactivation Date:2022-04-12
Deactivation Code:
Reactivation Date:2022-05-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501081905Medicaid
MO0180000Medicare ID - Type Unspecified