Individual
KEENAN R BERGHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2790 CLAY EDWARDS DR STE 625, NORTH KANSAS CITY, MO 64116-3278
(816) 455-3990
(816) 455-5351
Mailing address
2790 CLAY EDWARDS DR STE 625, NORTH KANSAS CITY, MO 64116-3278
(816) 455-3990
(816) 455-5351
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01063361A
IN
208600000X
Surgery Physician
Primary
115623
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000607167
ANTHEM
IN
05
—
200855420
—
IN
Enumeration date
06/06/2006
Last updated
02/18/2021
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