Provider Demographics
NPI:1356736136
Name:WERTH, KYLE CHRISTOPHER
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:CHRISTOPHER
Last Name:WERTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 CORPORATE AVE STE 342
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1374
Mailing Address - Country:US
Mailing Address - Phone:913-588-6111
Mailing Address - Fax:
Practice Address - Street 1:11300 CORPORATE AVE STE 342
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1374
Practice Address - Country:US
Practice Address - Phone:913-588-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI730232085D0003X
NE333672085R0202X
WY13525A2085R0202X
WI73023-202085R0202X
KS04-422122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging