Provider Demographics
NPI:1730114109
Name:NEWMAN, KENNETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:NEWMAN
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:PO BOX 411712
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1712
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-789-5561
Practice Address - Fax:913-789-1835
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8641207PE0005X
KS04-26120207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100125150EMedicaid
KSP01219326OtherRR
KS100125150CMedicaid
MO1730114109Medicaid
KS100125150DMedicaid
KS48056018OtherBCBSKC
MOP01193491OtherRR
KS48056018OtherBCBSKC
KSP01219326OtherRR
KS100125150EMedicaid