Healthcare Provider Details

I. General information

NPI: 1528529054
Provider Name (Legal Business Name): JONATHAN BERNARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 W 135TH ST
LEAWOOD KS
66224-8901
US

IV. Provider business mailing address

4801 W 135TH ST
LEAWOOD KS
66224-8901
US

V. Phone/Fax

Practice location:
  • Phone: 913-663-3838
  • Fax: 913-663-4434
Mailing address:
  • Phone: 913-663-3838
  • Fax: 913-663-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number04-53234
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: