Healthcare Provider Details

I. General information

NPI: 1235204785
Provider Name (Legal Business Name): COLETTE A FLEMING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

IV. Provider business mailing address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

V. Phone/Fax

Practice location:
  • Phone: 816-474-4920
  • Fax: 816-474-4914
Mailing address:
  • Phone: 816-474-4920
  • Fax: 816-474-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-17826
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: