Provider Demographics
NPI:1407040967
Name:OVERLAND PARK MEDICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:OVERLAND PARK MEDICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-599-3828
Mailing Address - Street 1:10550 QUIVIRA RD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2306
Mailing Address - Country:US
Mailing Address - Phone:913-599-3828
Mailing Address - Fax:913-599-3451
Practice Address - Street 1:10550 QUIVIRA RD
Practice Address - Street 2:SUITE 530
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-599-3828
Practice Address - Fax:913-599-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28969207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200517020AMedicaid
MO507018208Medicaid
KSDG6338Medicare PIN
KS200517020AMedicaid