Healthcare Provider Details

I. General information

NPI: 1780689885
Provider Name (Legal Business Name): DANIEL J GEHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 STATE LINE RD
LEAWOOD KS
66206-1553
US

IV. Provider business mailing address

8800 STATE LINE RD
LEAWOOD KS
66206-1553
US

V. Phone/Fax

Practice location:
  • Phone: 913-383-9099
  • Fax: 913-383-9611
Mailing address:
  • Phone: 913-383-9099
  • Fax: 913-383-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0425005
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: