Provider Demographics
NPI:1871686279
Name:DETAR NEWBERT, LEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:
Last Name:DETAR NEWBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CARONDELET DR
Mailing Address - Street 2:PROVIDER ENROLLMENT/MED STAFF OFC
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-943-5744
Mailing Address - Fax:816-943-2767
Practice Address - Street 1:15604 PINEHURST DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-8233
Practice Address - Country:US
Practice Address - Phone:913-728-2200
Practice Address - Fax:913-728-2230
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
16165039OtherBCBS KANSAS CITY
E73821Medicare UPIN
M542267Medicare ID - Type UnspecifiedKANSAS CITY