Provider Demographics
NPI:1699878686
Name:LATINIS, KEVIN M (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:LATINIS
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 1:14641 BRIAR ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14641 BRIAR ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-3766
Practice Address - Country:US
Practice Address - Phone:913-555-5555
Practice Address - Fax:913-555-5555
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30721207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34107011OtherBCBS KC
KS200265790AMedicaid
MO205690217Medicaid
KS479360OtherFIRSTGUARD
MO205690217Medicaid
MO34107011OtherBCBS KC
KSP00159046Medicare ID - Type UnspecifiedRAILROAD MEDICARE