Healthcare Provider Details

I. General information

NPI: 1972833457
Provider Name (Legal Business Name): VEIN & LASER INSTITUTE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CARONDELET DR SUITE 140
KANSAS CITY MO
64114-4859
US

IV. Provider business mailing address

1010 CARONDELET DR SUITE 140
KANSAS CITY MO
64114-4859
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-0199
  • Fax: 816-943-0323
Mailing address:
  • Phone: 816-943-0199
  • Fax: 816-943-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number106993
License Number StateMO

VIII. Authorized Official

Name: VICTORIA KNOX
Title or Position: MANAGER
Credential:
Phone: 816-943-0199