Provider Demographics
NPI:1881621209
Name:PLACE, KENNETH CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CRAIG
Last Name:PLACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 ROE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2202
Mailing Address - Country:US
Mailing Address - Phone:913-385-9009
Mailing Address - Fax:913-385-3005
Practice Address - Street 1:9009 ROE AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2202
Practice Address - Country:US
Practice Address - Phone:913-385-9009
Practice Address - Fax:913-385-3005
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-17640207W00000X
MO35062207W00000X
MI4301047588207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E22813Medicare UPIN
4983944CMedicare ID - Type Unspecified