Healthcare Provider Details

I. General information

NPI: 1457037111
Provider Name (Legal Business Name): BLAKE L SUMMERS MS GC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 SHAWNEE MISSION PKWY STE 317
WESTWOOD KS
66205-2005
US

IV. Provider business mailing address

3535 BROADWAY BLVD APT 214
KANSAS CITY MO
64111
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-0592
  • Fax: 913-574-1274
Mailing address:
  • Phone: 913-588-0592
  • Fax: 913-574-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: