Healthcare Provider Details

I. General information

NPI: 1881041549
Provider Name (Legal Business Name): KANSAS CITY FAMILY ALLERGY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 CARONDELET DR SUITE 335
KANSAS CITY MO
64114-4801
US

IV. Provider business mailing address

1004 CARONDELET DR SUITE 335
KANSAS CITY MO
64114-4801
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-6400
  • Fax: 816-941-6404
Mailing address:
  • Phone: 816-941-6400
  • Fax: 816-941-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number100376
License Number StateMO

VIII. Authorized Official

Name: DR. F, SCOTT DATTEL
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 816-941-6400