Healthcare Provider Details

I. General information

NPI: 1831137462
Provider Name (Legal Business Name): DERMATOLOGY SPECIALISTS OF KANSAS CITY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CARONDELET DR SUITE 125
KANSAS CITY MO
64114-4859
US

IV. Provider business mailing address

1010 CARONDELET DR STE 125
KANSAS CITY MO
64114-4846
US

V. Phone/Fax

Practice location:
  • Phone: 816-942-1150
  • Fax: 816-942-0322
Mailing address:
  • Phone: 816-942-1150
  • Fax: 816-942-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. SUE MECHANIC
Title or Position: ADMINISTRATOR
Credential:
Phone: 816-942-1150