Provider Demographics
NPI:1851484430
Name:GRAVES, LELAND III (MD)
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:
Last Name:GRAVES
Suffix:III
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 1:3901 RAINBOW BLVD. MS 2024
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6022
Mailing Address - Fax:913-588-4060
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6022
Practice Address - Fax:913-535-2101
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20561207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13922030OtherBCBS KC
MO202519021Medicaid
KS100114070BMedicaid
KS303043OtherFIRSTGUARD
E24088Medicare UPIN
KS100114070BMedicaid
MO13922030OtherBCBS KC