Healthcare Provider Details

I. General information

NPI: 1891866018
Provider Name (Legal Business Name): ALAN P WIMMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 WORNALL RD SUITE 2000
KANSAS CITY MO
64111-5939
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400S
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-1883
  • Fax: 816-756-3645
Mailing address:
  • Phone: 816-502-7117
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2007008383
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: