Healthcare Provider Details

I. General information

NPI: 1982308375
Provider Name (Legal Business Name): BRADEN ZOLLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

11321 W 131ST ST
OVERLAND PARK KS
66213-4480
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-4175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2025041574
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: