Healthcare Provider Details

I. General information

NPI: 1376524298
Provider Name (Legal Business Name): FEDERICO GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date: 11/08/2005
Reactivation Date: 10/31/2006

III. Provider practice location address

23351 PRAIRIE STAR PKWY STE 125
LENEXA KS
66227-6201
US

IV. Provider business mailing address

119 N PARKER ST # 284
OLATHE KS
66061-3139
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-8626
  • Fax: 913-676-8649
Mailing address:
  • Phone: 913-660-4742
  • Fax: 913-204-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0426273
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number0426273
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: