# KANSAS CITY VASCULAR INSTITUTE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568158202
- **Authorized official:** JUAN CARLOS CORREA MD (MD/OWNER)
- **Authorized official phone:** (314) 698-8894

## Contact information

- **Practice address:** 5320 COLLEGE BLVD, LEAWOOD, KS 66211-1621
- **Practice address phone:** (913) 279-0233
- **Practice address fax:** (830) 632-6568
- **Mailing address:** 5320 COLLEGE BLVD, LEAWOOD, KS 66211-1621
- **Mailing address phone:** (913) 279-0233
- **Mailing address fax:** (830) 632-6568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | — | NULL | — |
| 363LA2100X | Acute Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/14/2023
- **Last updated:** 05/23/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 30004944060001 | — | KS |
| 05 | — | 500124730 | — | MO |