Provider Demographics
NPI:1497749295
Name:KAVAN, JOEL D (DO)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:KAVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 STATE LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4263
Mailing Address - Country:US
Mailing Address - Phone:816-354-3090
Mailing Address - Fax:816-354-3091
Practice Address - Street 1:10205 STATE LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4263
Practice Address - Country:US
Practice Address - Phone:816-354-3090
Practice Address - Fax:816-354-3091
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0527608207Q00000X
MO2024000134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H24219Medicare UPIN
KS105635Medicare PIN