Provider Demographics
NPI:1659362648
Name:JANTZ, GERALD KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:KEITH
Last Name:JANTZ
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 1:12504 CATALINA ST.
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209
Mailing Address - Country:US
Mailing Address - Phone:816-363-4100
Mailing Address - Fax:816-363-4393
Practice Address - Street 1:12504 CATALINA ST.
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209
Practice Address - Country:US
Practice Address - Phone:816-210-6625
Practice Address - Fax:816-262-4393
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1D18207R00000X
KS04-25021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208461004Medicaid
KS200307310Medicaid
MO5236096Medicare ID - Type UnspecifiedMEDICARE - MO AND KS
KS200307310Medicaid