Provider Demographics
NPI:1548472954
Name:MONGEAU, KIMBERLY KAY (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:MONGEAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5909 N AMES AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4101 S 4TH ST
Practice Address - Street 2:DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5014
Practice Address - Country:US
Practice Address - Phone:913-782-2000
Practice Address - Fax:913-758-4280
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN8334208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation