Healthcare Provider Details

I. General information

NPI: 1760486674
Provider Name (Legal Business Name): SUSAN K BONAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11237 NALL AVE STE 130
LEAWOOD KS
66211-1655
US

IV. Provider business mailing address

11237 NALL AVE STE 130
LEAWOOD KS
66211-1655
US

V. Phone/Fax

Practice location:
  • Phone: 913-469-3690
  • Fax: 913-469-3692
Mailing address:
  • Phone: 913-469-3690
  • Fax: 913-469-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number04-29549
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number0429549
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: