Healthcare Provider Details

I. General information

NPI: 1912954447
Provider Name (Legal Business Name): LAURA FITZMAURICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

700 W 111TH TER
KANSAS CITY MO
64114-5107
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3897
  • Fax: 816-802-1114
Mailing address:
  • Phone: 816-943-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMDR2H42
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: