Provider Demographics
NPI:1821087255
Name:ALFIERI, KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:ALFIERI
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 1:12800 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19609 E 9TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056-3088
Practice Address - Country:US
Practice Address - Phone:816-796-1412
Practice Address - Fax:816-796-3398
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8D542085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100208050DMedicaid
MO202129524Medicaid
KSP00313597OtherRR MEDICARE
MO300118566OtherRAILROAD MEDICARE
KSP00313597Medicare PIN
MO0567234BMedicare PIN
MOK677234Medicare PIN
MO300118566OtherRAILROAD MEDICARE
MOC51402Medicare UPIN
MO300118566Medicare PIN
KSP00313597OtherRR MEDICARE