Healthcare Provider Details

I. General information

NPI: 1962553529
Provider Name (Legal Business Name): SUSAN L STORM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8781 NORTH PLATTE PURCHASE DRIVE
KANSAS CITY MO
64155
US

IV. Provider business mailing address

8781 NORTH PLATTE PURCHASE DRIVE
KANSAS CITY MO
64155
US

V. Phone/Fax

Practice location:
  • Phone: 816-587-3299
  • Fax: 816-587-7644
Mailing address:
  • Phone: 816-587-3299
  • Fax: 816-587-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR4H36
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: