Healthcare Provider Details

I. General information

NPI: 1265490817
Provider Name (Legal Business Name): CHARLES E RHOADES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 COLLEGE BLVD
LEAWOOD KS
66211-1910
US

IV. Provider business mailing address

3651 COLLEGE BLVD
LEAWOOD KS
66211-1910
US

V. Phone/Fax

Practice location:
  • Phone: 913-319-7600
  • Fax: 913-253-1702
Mailing address:
  • Phone: 913-319-7600
  • Fax: 913-253-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberR9481
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number04-18540
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: