Provider Demographics
NPI:1427331586
Name:GOETZ, KENNETH LEE (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEE
Last Name:GOETZ
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 1:9535 ASH ST
Mailing Address - Street 2:#211
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-3291
Mailing Address - Country:US
Mailing Address - Phone:913-341-5647
Mailing Address - Fax:
Practice Address - Street 1:9535 ASH ST
Practice Address - Street 2:#211
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-3291
Practice Address - Country:US
Practice Address - Phone:913-341-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine