Provider Demographics
NPI:1881607323
Name:BERGER-GILLEN, KATHLEEN P (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:BERGER-GILLEN
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 1:10310 STATE LINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2695
Mailing Address - Country:US
Mailing Address - Phone:913-647-4101
Mailing Address - Fax:913-647-4121
Practice Address - Street 1:1000 CARONDELET DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:816-943-2252
Practice Address - Fax:816-943-4656
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111535207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208496604Medicaid
MO23580016OtherBCBS OF KANSAS CITY
MO100266340AMedicaid
MO100266340AMedicaid
MO4959492Medicare ID - Type Unspecified
MO208496604Medicaid