Provider Demographics
NPI:1780844324
Name:K DEAN REEVES MD PA
Entity Type:Organization
Organization Name:K DEAN REEVES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-362-1600
Mailing Address - Street 1:4740 EL MONTE ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1348
Mailing Address - Country:US
Mailing Address - Phone:913-362-1600
Mailing Address - Fax:913-362-4452
Practice Address - Street 1:4740 EL MONTE ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-1348
Practice Address - Country:US
Practice Address - Phone:913-362-1600
Practice Address - Fax:913-362-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-19247208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100198030AMedicaid
KSD16865Medicare UPIN
KS0006081BMedicare Oscar/Certification