Provider Demographics
NPI:1215976972
Name:TREFFER, KEVIN (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:TREFFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:SUITE #220
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4859
Mailing Address - Country:US
Mailing Address - Phone:816-941-1600
Mailing Address - Fax:816-941-1699
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE #220
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-941-1600
Practice Address - Fax:816-941-1699
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MODO R9H25207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010027364OtherRAILROAD MEDICARE
MO242553709Medicaid
2300063Medicare ID - Type Unspecified
MO242553709Medicaid