Provider Demographics
NPI:1952337735
Name:KORENTAGER, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:KORENTAGER
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 1:3901 RAINBOW BLVD
Mailing Address - Street 2:4070 DELP, MAILSTOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-2527
Mailing Address - Fax:913-588-1445
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-2067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427388208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204625701Medicaid
25162093OtherBCBS OF KANSAS CITY
KS0098692AMedicare ID - Type Unspecified
240006186Medicare ID - Type UnspecifiedRAILROAD
25162093OtherBCBS OF KANSAS CITY
KSM688992Medicare ID - Type Unspecified
MO204625701Medicaid