Individual
DR. KELVIN L WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4880 NW GOODVIEW CIRCLE, LEES SUMMIT, MO 64064
(816) 478-4200
(816) 478-0507
Mailing address
3340 NE RALPH POWELL RD, SUITE B, LEES SUMMIT, MO 64064-2368
(816) 875-2599
(816) 875-2598
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
102064
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1008079
UHC
MO
01
—
18599040
BCBS
MO
01
—
18599050
BCBS OF KC
MO
01
—
204510882
CHAMPUS
MO
01
—
27731
BNDD
MO
01
—
4267247
AETNA
MO
Enumeration date
02/13/2006
Last updated
03/07/2023
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