Provider Demographics
NPI:1245333137
Name:KESTENBAUM, THELDA M (MD)
Entity type:Individual
Prefix:
First Name:THELDA
Middle Name:M
Last Name:KESTENBAUM
Suffix:
Gender:F
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.
Mailing Address - Street 2:MS 2025
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-3840
Mailing Address - Fax:913-588-8761
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:DEPT OF INTERNAL MEDICINE
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-17264207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100195180AMedicaid
MO06856030OtherBCBS KC
MS200982205Medicaid
KS626230OtherFIRSTGUARD
MO06856030OtherBCBS KC
C52198Medicare UPIN
KS080082449Medicare ID - Type UnspecifiedRAILROAD MEDICARE