Provider Demographics
NPI:1508958679
Name:REEVES, KENNETH DEAN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DEAN
Last Name:REEVES
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 1:4740 EL MONTE ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1348
Mailing Address - Country:US
Mailing Address - Phone:913-362-1600
Mailing Address - Fax:913-362-4452
Practice Address - Street 1:4740 EL MONTE ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-1348
Practice Address - Country:US
Practice Address - Phone:913-362-1600
Practice Address - Fax:913-362-4452
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-19247208100000X, 2081P2900X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100198030AMedicaid
KSD16865Medicare UPIN
KS100198030AMedicaid