Provider Demographics
NPI:1265504971
Name:GEENENS, DOUGLAS L (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:GEENENS
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 1:4901 W 136TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-5926
Mailing Address - Country:US
Mailing Address - Phone:913-488-2012
Mailing Address - Fax:913-890-7285
Practice Address - Street 1:4901 W 136TH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-5926
Practice Address - Country:US
Practice Address - Phone:913-488-2012
Practice Address - Fax:913-890-7285
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05225772084P0800X
KS74557363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
L926050Medicare ID - Type Unspecified
F59463Medicare UPIN