Organization
MIDWEST DOCTORS GROUP, LLC
Active
Other names
Mid-America Sports Medicine and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK J KUENY (VICE PRESIDENT)
(816) 508-4090
Entity
Organization
Contact information
Practice address
19550 E 39TH ST S, SUITE 419, INDEPENDENCE, MO 64057-2303
(816) 795-8200
(816) 795-7735
Mailing address
19550 E 39TH ST S, SUITE 419, INDEPENDENCE, MO 64057-2303
(816) 795-8200
(816) 795-7735
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841462314
—
MO
05
—
200584160 A
—
KS
05
—
200584160 B
—
KS
Enumeration date
03/25/2008
Last updated
12/16/2009
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