Provider Demographics
NPI:1013282664
Name:PLUENNEKE, KIMBERLY KAY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:PLUENNEKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9200 INDIAN CREEK PKWY
Mailing Address - Street 2:BLDG. 9, STE. 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2036
Mailing Address - Country:US
Mailing Address - Phone:913-541-4600
Mailing Address - Fax:913-541-4692
Practice Address - Street 1:8700 N GREEN HILLS RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1910
Practice Address - Country:US
Practice Address - Phone:816-745-4670
Practice Address - Fax:816-745-4698
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105374207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF76363Medicare UPIN