Provider Demographics
NPI:1194948778
Name:KUYKENDALL, SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 WASHINGTON ST STE 5300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5931
Mailing Address - Country:US
Mailing Address - Phone:816-531-1234
Mailing Address - Fax:816-531-0737
Practice Address - Street 1:4321 WASHINGTON ST STE 5300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5931
Practice Address - Country:US
Practice Address - Phone:816-531-1234
Practice Address - Fax:816-531-0737
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35782208800000X
MO2012017449208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
47807015OtherBCBS KC
KSP01229653OtherRR MEDICARE
KSJ71000017Medicare PIN
KSP01229653OtherRR MEDICARE