Provider Demographics
NPI:1245452895
Name:SHAUMEYER, KRISTI (MD)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:SHAUMEYER
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:PO BOX 875743
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-5743
Mailing Address - Country:US
Mailing Address - Phone:913-215-5008
Mailing Address - Fax:816-880-2640
Practice Address - Street 1:3066 SW GRANDSTAND CIR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3866
Practice Address - Country:US
Practice Address - Phone:913-215-5008
Practice Address - Fax:816-880-2640
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008005526207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1649277401Medicaid
H71000004Medicare PIN