Berghoff, Keenan R

Berghoff, Keenan R is an individual health care provider with primary practice located at 2790 Clay Edwards Dr Ste 625 , North Kansas City MO 64116-3278. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Berghoff, Keenan R can be contacted via phone (816) 455-3990.

Contact Information

Primary practice address
2790 Clay Edwards Dr Ste 625 North Kansas City MO 64116-3278
Phone: (816) 455-3990
Fax: (816) 455-5351
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 01063361A Indiana
Allopathic & Osteopathic Physicians / Surgery 208600000X 115623 Missouri

Profile Details

NPI number 1720027212
LBN Legal business name Berghoff, Keenan R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Feb 18th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720027212 NPPES
Indiana Other 000000607167 ANTHEM
Indiana MEDICAID 200855420 ANTHEM

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