Provider Demographics
NPI:1801894258
Name:GAGE, BETSE M (MD)
Entity type:Individual
Prefix:
First Name:BETSE
Middle Name:M
Last Name:GAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8800 W 75TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2205
Mailing Address - Country:US
Mailing Address - Phone:913-384-5500
Mailing Address - Fax:913-384-5209
Practice Address - Street 1:21 N 12TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5161
Practice Address - Country:US
Practice Address - Phone:913-342-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8D73208000000X
KS0420438208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100151790BMedicaid