Basic Information
Provider Information
NPI: 1487142154
EntityType: 2
ReplacementNPI:  
OrganizationName: UNIVERSITY OF KANSAS PHYSICIANS
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Mailing Information
Address1: 3901 RAINBOW BLVD # MS 1034
Address2:  
City: KANSAS CITY
State: KS
PostalCode: 661608500
CountryCode: US
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Practice Location
Address1: 3901 RAINBOW BLVD
Address2:  
City: KANSAS CITY
State: KS
PostalCode: 661608500
CountryCode: US
TelephoneNumber: 9135886670
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/27/2018
LastUpdateDate: 04/27/2018
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AuthorizedOfficialLastName: BRACKEN
AuthorizedOfficialFirstName: JOHN
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AuthorizedOfficialTitleorPosition: SUPERVISOR
AuthorizedOfficialTelephone: 9135886670
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X04-39841KSY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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