Healthcare Provider Details

I. General information

NPI: 1043204852
Provider Name (Legal Business Name): MID-AMERICA RHEUMATOLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W 119TH ST SUITE 209
OVERLAND PARK KS
66209-3722
US

IV. Provider business mailing address

5701 W 119TH ST SUITE 209
OVERLAND PARK KS
66209-3722
US

V. Phone/Fax

Practice location:
  • Phone: 913-661-9980
  • Fax: 913-661-9173
Mailing address:
  • Phone: 913-661-9980
  • Fax: 913-661-9173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: ANGELA THERESE CHLADEK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 913-661-9980