Healthcare Provider Details

I. General information

NPI: 1932215506
Provider Name (Legal Business Name): VISESLAV TONKOVIC-CAPIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13284 HIGH DR
LEAWOOD KS
66209-1667
US

IV. Provider business mailing address

13284 HIGH DR
LEAWOOD KS
66209-1667
US

V. Phone/Fax

Practice location:
  • Phone: 913-963-5456
  • Fax:
Mailing address:
  • Phone: 913-963-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number04-31955
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number2009006327
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number04-31955
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberN8251
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC55335
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2009006327
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberN8251
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC55335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: