1346237088 NPI number — DANIEL R KLOSTER M. D.

Table of content: DANIEL R KLOSTER M. D. (NPI 1346237088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346237088 NPI number — DANIEL R KLOSTER M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLOSTER
Provider First Name:
DANIEL
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346237088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 COLLEGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66210-1862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-242-7570
Provider Business Mailing Address Fax Number:
913-242-7572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5701 W 119TH ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-498-6124
Provider Business Practice Location Address Fax Number:
913-498-6117
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  118941 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 118941 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 208858621 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7905560001 . This is a "DME" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 073057 . This is a "FHP MEDICAID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 26073028 . This is a "BCBS OF KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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