Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2002010569 | MO |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 2002010569 | MO |
NPI | 1831230655 |
---|---|
Provider Name | Dr. Kent M. Burk |
First Address | Kansas City, MO 64108-2602 |
Second Address | Kansas City, MO 64108-2727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 19/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
148763001 | (05) | MO |
205852908 | (05) | MO |
99350 | AR BLUE SHIELD # (01) | MO |
E85076 | (02) | MO |