Provider Demographics
NPI:1811994239
Name:GINSBERG, BRENT WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:WILLIAM
Last Name:GINSBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:B
Other - Middle Name:WILLIAM
Other - Last Name:GINSBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2330 E MEYER BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4185
Mailing Address - Country:US
Mailing Address - Phone:816-333-5424
Mailing Address - Fax:816-822-0870
Practice Address - Street 1:2330 E MEYER BLVD
Practice Address - Street 2:STE 301
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4185
Practice Address - Country:US
Practice Address - Phone:816-333-5424
Practice Address - Fax:816-822-0870
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9326207RG0100X
KS17236207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100003019OtherRR MEDICARE
MO201354313Medicaid
KS100203510AMedicaid
100003019OtherRR MEDICARE
MO201354313Medicaid