Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 04-18081 | KS |
N | 207YS0123X | Facial Plastic Surgeon | R9029 | MO |
NPI | 1023180700 |
---|---|
Provider Name | Dr. Kenneth Allan Buchwach |
First Address | Overland Park, KS 66209-3722 |
Second Address | Overland Park, KS 66209-3722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C03536 | (02) | KS |