Individual
KENNETH KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 CARONDELET DR, KANSAS CITY, MO 64114-4673
(913) 599-6777
(913) 599-3955
Mailing address
8000 W 110TH ST, STE 150, OVERLAND PARK, KS 66210-2382
(913) 599-6777
(913) 599-3955
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
4272-320
WI
2085R0202X
Diagnostic Radiology Physician
Primary
R3M47
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100126630B
—
KS
01
—
16332035
BCBS PROVIDER NUMBER
—
05
—
203305107
—
MO
Enumeration date
06/05/2006
Last updated
07/31/2025
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