Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 0522106 | KS |
NPI | 1275508723 |
---|---|
Provider Name | Dr. O. Keith Enlow |
First Address | Olathe, KS 66061-7216 |
Second Address | Olathe, KS 66061-7216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 30/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100230340A | (05) | KS |
13360014 | BLUE SHIELD (01) | MO |