Provider Demographics
NPI:1144475070
Name:KINDER, KATHY LAKE (MD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LAKE
Last Name:KINDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2640
Mailing Address - Country:US
Mailing Address - Phone:816-235-1972
Mailing Address - Fax:816-235-5538
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-235-1972
Practice Address - Fax:816-235-5538
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22040207R00000X
MOR7J60207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0009255Medicare PIN
KSD05383Medicare UPIN
MO0009255AMedicare PIN