Healthcare Provider Details

I. General information

NPI: 1780777029
Provider Name (Legal Business Name): DAVID CARL DAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

14823 W 71ST TER
SHAWNEE KS
66216-4008
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7500
  • Fax:
Mailing address:
  • Phone: 913-962-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR7G05
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: