Healthcare Provider Details

I. General information

NPI: 1972705366
Provider Name (Legal Business Name): SUZANNE GRILLOT ELTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE MICHELLE GRILLOT M.D.

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 NALL AVE SUITE 200
OVERLAND PARK KS
66211-1231
US

IV. Provider business mailing address

12639 OLD TESSON RD SUITE 100
SAINT LOUIS MO
63128-2786
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-5225
  • Fax: 913-341-3940
Mailing address:
  • Phone: 314-849-0311
  • Fax: 314-849-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number04-33104
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number2008020473
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: