Provider Demographics
NPI:1992945307
Name:KC BARIATRIC, LLC
Entity type:Organization
Organization Name:KC BARIATRIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-677-6319
Mailing Address - Street 1:PO BOX 7913
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-7913
Mailing Address - Country:US
Mailing Address - Phone:913-677-6319
Mailing Address - Fax:913-677-1540
Practice Address - Street 1:23401 PRAIRIE STAR PARKWAY
Practice Address - Street 2:SUITE B-300
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227
Practice Address - Country:US
Practice Address - Phone:913-677-6319
Practice Address - Fax:913-677-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty