Provider Demographics
NPI:1710071261
Name:CRENNER, CHRISTOPHER W (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:CRENNER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KANSAS UNIVERSITY PHYSICIANS INC
Mailing Address - Street 2:3901 RAINBOW BLVD,, 4070 DELP, MS 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-2500
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD, DELP 6040, MS 1020
Practice Address - Street 2:KANSAS UNIVERSITY PHYSICIANS INC
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-3974
Practice Address - Fax:913-588-6055
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203776208Medicaid
KS655120OtherFIRSTGUARD
KS100318670AMedicaid
MO25159023OtherBCBS KC
MO203776208Medicaid
MO25159023OtherBCBS KC
KS0118478AMedicare ID - Type Unspecified