Healthcare Provider Details

I. General information

NPI: 1073543070
Provider Name (Legal Business Name): PLAZA INFECTIOUS DISEASE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WORNALL RD SUITE 440
KANSAS CITY MO
64111-5941
US

IV. Provider business mailing address

4320 WORNALL RD SUITE 440
KANSAS CITY MO
64111-5941
US

V. Phone/Fax

Practice location:
  • Phone: 816-531-1550
  • Fax: 816-531-8277
Mailing address:
  • Phone: 816-531-1550
  • Fax: 816-531-8277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DIXIE D FREEBORN
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-531-1550