Provider Demographics
NPI:1043291297
Name:FREEMAN, KENTON C (MD)
Entity type:Individual
Prefix:DR
First Name:KENTON
Middle Name:C
Last Name:FREEMAN
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 1:2201 RED OAK CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4936
Mailing Address - Country:US
Mailing Address - Phone:816-233-0211
Mailing Address - Fax:816-233-8196
Practice Address - Street 1:218 S WOODBINE RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3447
Practice Address - Country:US
Practice Address - Phone:816-383-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104065208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO250008744OtherRR MEDICARE #
MO208721506Medicaid
MOG50233OtherUPIN
MO24719017OtherBC/BS OF KC
MO0008108OtherMEDICARE PROV #