Provider Demographics
NPI:1447270863
Name:ROBERTS, KIRK ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:ANDREW
Last Name:ROBERTS
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:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66201-0716
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:20333 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5350
Practice Address - Country:US
Practice Address - Phone:913-791-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0425141207PE0005X, 207P00000X
MOR2K05207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100164080CMedicaid
KS2087736OtherUHC
KS100164080FMedicaid
MO1447270863Medicaid
KS4568814OtherAETNA
KS930110723OtherRR MEDICARE
KS15538091OtherBCBS
KSP00812189OtherRR MEDICARE - WHA
MO263A00204Medicare PIN
KS100164080CMedicaid
KS2087736OtherUHC
KSKA1657003Medicare PIN