Provider Demographics
NPI:1669439097
Name:EUBANKS-MENG, KATHLEEN M (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:EUBANKS-MENG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5501 NW 62ND TER STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2412
Mailing Address - Country:US
Mailing Address - Phone:816-842-4440
Mailing Address - Fax:816-842-1974
Practice Address - Street 1:3601 NE RALPH POWELL RD
Practice Address - Street 2:STE C
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2358
Practice Address - Country:US
Practice Address - Phone:816-285-5053
Practice Address - Fax:816-842-1974
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207288101Medicaid
MO207288101Medicaid
F88C553Medicare ID - Type Unspecified