Individual
KELLI JO ANDRESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4401 WORNALL RD, RADIOLOGY DEPT, KANSAS CITY, MO 64111-3220
(816) 932-2000
Mailing address
901 E 104TH ST, MAILSTOP 400S, KANSAS CITY, MO 64131-4517
(816) 599-9499
(816) 932-9670
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2008002389
MO
2085R0202X
Diagnostic Radiology Physician
36297
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0472795
—
IA
05
—
1073597514
—
MO
05
—
200564680A
—
KS
01
—
37843017
BCBS KANSAS CITY
MO
01
—
37843027
BCBS KC GRP# 18959016
MO
01
—
39890
WELLMARK BCBS
IA
01
—
P00475714
RAILROAD MEDICARE
MO
Enumeration date
11/29/2005
Last updated
12/01/2017
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