Healthcare Provider Details

I. General information

NPI: 1972859510
Provider Name (Legal Business Name): FOREST PARK NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 E TRUMAN RD
KANSAS CITY MO
64126-2400
US

IV. Provider business mailing address

5811 E TRUMAN RD
KANSAS CITY MO
64126-2400
US

V. Phone/Fax

Practice location:
  • Phone: 816-600-1816
  • Fax: 877-274-1845
Mailing address:
  • Phone: 816-600-1816
  • Fax: 877-274-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number1116914
License Number StateMO

VIII. Authorized Official

Name: MRS. ANA V ANGELES
Title or Position: PRACTICE COORDINATOR
Credential: CPC
Phone: 847-251-2400