Provider Demographics
NPI:1326188046
Name:DAVIES, KIM M (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:M
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7844 QUIVIRA RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66216-3322
Mailing Address - Country:US
Mailing Address - Phone:913-631-8486
Mailing Address - Fax:913-948-9877
Practice Address - Street 1:7844 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66216-3322
Practice Address - Country:US
Practice Address - Phone:913-631-8486
Practice Address - Fax:913-948-9877
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110983207R00000X
KS04-25902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E54939Medicare UPIN
T48E222Medicare ID - Type Unspecified