Healthcare Provider Details

I. General information

NPI: 1285601500
Provider Name (Legal Business Name): SUZANNE M HESTWOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2634
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7000
  • Fax:
Mailing address:
  • Phone: 816-218-2500
  • Fax: 816-421-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number102767
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: