Healthcare Provider Details

I. General information

NPI: 1023253176
Provider Name (Legal Business Name): JAMES E GRACHECK, D O P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W 72ND ST
KANSAS CITY MO
64114-5702
US

IV. Provider business mailing address

8607 E 77TH ST
KANSAS CITY MO
64138-1210
US

V. Phone/Fax

Practice location:
  • Phone: 816-444-0025
  • Fax: 816-444-0007
Mailing address:
  • Phone: 816-358-1231
  • Fax: 816-743-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33627
License Number StateMO

VIII. Authorized Official

Name: DR. JAMES E GRACHECK
Title or Position: OWNER
Credential: D.O.
Phone: 816-444-0025