Provider Demographics
NPI:1871556423
Name:RHODES-STARK, KELLY L (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:RHODES-STARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:RHODES-STARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6601 WINCHESTER AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4677
Mailing Address - Country:US
Mailing Address - Phone:816-313-2677
Mailing Address - Fax:816-313-6000
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 180
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5306
Practice Address - Country:US
Practice Address - Phone:913-768-7200
Practice Address - Fax:913-768-9714
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1048762085R0001X
KS04-246062085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208300806Medicaid
KS100192460AMedicaid
KS100192460AMedicaid
MO208300806Medicaid
MO4229347AMedicare PIN