Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2014017701 | MO |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2014017701 | MO |
NPI | 1174834378 |
---|---|
Provider Name | Kyle Schneweis |
First Address | Kansas City, MO 64121-9672 |
Second Address | Liberty, MO 64068-3313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 09/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50454018 | BCBS (01) | MO |