Provider Demographics
NPI:1467461269
Name:HAVERKAMP, KENT D (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:D
Last Name:HAVERKAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 SE WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-2189
Mailing Address - Country:US
Mailing Address - Phone:785-267-0744
Mailing Address - Fax:785-266-3490
Practice Address - Street 1:2909 SE WALNUT DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2189
Practice Address - Country:US
Practice Address - Phone:785-267-0744
Practice Address - Fax:785-266-3490
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100143740BMedicaid
F55317Medicare UPIN
KS100143740BMedicaid