Provider Demographics
NPI:1972576593
Name:WALLS, KELVIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:L
Last Name:WALLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3340 NE RALPH POWELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2368
Mailing Address - Country:US
Mailing Address - Phone:816-875-2599
Mailing Address - Fax:816-875-2598
Practice Address - Street 1:4880 NW GOODVIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-478-4200
Practice Address - Fax:816-478-0507
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO102064207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18599040OtherBCBS
MO18599050OtherBCBS OF KC
MO1008079OtherUHC
MO27731OtherBNDD
MO4267247OtherAETNA
MO204510882OtherCHAMPUS
MOBW3389916OtherDEA
MO18599040OtherBCBS
MO18599050OtherBCBS OF KC
MO4267247OtherAETNA