Provider Demographics
NPI:1649333741
Name:KRAFT, SHANNON MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARIE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1917 W 48TH ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1902
Mailing Address - Country:US
Mailing Address - Phone:913-499-1108
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD MSC 3010
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6739
Practice Address - Fax:913-588-4676
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS9406641207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology