Healthcare Provider Details

I. General information

NPI: 1306093059
Provider Name (Legal Business Name): WALTER FRANCISCO RICCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 SHAWNEE MISSION PKWY SUITE 252
FAIRWAY KS
66205-2507
US

IV. Provider business mailing address

4350 SHAWNEE MISSION PKWY SUITE 252
FAIRWAY KS
66205-2507
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-3399
  • Fax: 913-897-4317
Mailing address:
  • Phone: 913-677-3399
  • Fax: 913-897-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number04-14765
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33325
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: