Healthcare Provider Details

I. General information

NPI: 1235711227
Provider Name (Legal Business Name): DANIEL GORDON CHILCOTE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9686
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7100
  • Fax:
Mailing address:
  • Phone: 616-252-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2024023770
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: