Provider Demographics
NPI:1568570133
Name:GOULD, KEVIN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PAUL
Last Name:GOULD
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 1:21080 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7200
Mailing Address - Country:US
Mailing Address - Phone:913-768-3104
Mailing Address - Fax:913-768-0321
Practice Address - Street 1:21080 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7200
Practice Address - Country:US
Practice Address - Phone:913-768-3104
Practice Address - Fax:913-768-0321
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21743207P00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS03300012DMedicare PIN
C51562Medicare UPIN
KS868044OtherUHC
KS4082850OtherAETNA
KS930110415OtherRR MEDICARE
C51562Medicare UPIN
KS100115190BMedicaid
MO1568570133Medicaid