Healthcare Provider Details

I. General information

NPI: 1164622353
Provider Name (Legal Business Name): BETHLEHEM GELAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 MARSHALL DR SUITE 220
LENEXA KS
66214-1505
US

IV. Provider business mailing address

373 W 101ST TER
KANSAS CITY MO
64114-4408
US

V. Phone/Fax

Practice location:
  • Phone: 816-942-8200
  • Fax:
Mailing address:
  • Phone: 816-942-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0436055
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2012035075
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: