Healthcare Provider Details

I. General information

NPI: 1922439546
Provider Name (Legal Business Name): VALDAZE MCDANIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2013
Last Update Date: 12/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 WENONGA LN
LEAWOOD KS
66209-1631
US

IV. Provider business mailing address

12702 WENONGA LN
LEAWOOD KS
66209-1631
US

V. Phone/Fax

Practice location:
  • Phone: 816-665-8008
  • Fax:
Mailing address:
  • Phone: 816-665-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number1744P3200X
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: