Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 2000163872 | MO |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 31371 | KS |
N | 207Q00000X | Family Doctor | 2000163872 | MO |
N | 207Q00000X | Family Doctor | 31371 | KS |
NPI | 1235260480 |
---|---|
Provider Name | Bethany Sue Klug |
First Address | Kansas City, MO 64131-1611 |
Second Address | Mission, KS 66205-3002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |