Healthcare Provider Details

I. General information

NPI: 1639115728
Provider Name (Legal Business Name): EMILY JO LOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 NE 81ST TER STE 105
KANSAS CITY MO
64158-1176
US

IV. Provider business mailing address

9151 NE 81ST TER STE 105
KANSAS CITY MO
64158-1176
US

V. Phone/Fax

Practice location:
  • Phone: 816-994-8787
  • Fax: 816-994-8788
Mailing address:
  • Phone: 816-994-8787
  • Fax: 816-994-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2009006311
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2009006311
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: