Healthcare Provider Details

I. General information

NPI: 1649235037
Provider Name (Legal Business Name): INFECTIOUS DISEASE ASSOCIATES OF KANSAS CITY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 E MEYER BLVD BLDG 2 SUITE 392
KANSAS CITY MO
64132-1105
US

IV. Provider business mailing address

2340 E MEYER BLVD BLDG 2 SUITE 392
KANSAS CITY MO
64132-1105
US

V. Phone/Fax

Practice location:
  • Phone: 816-822-8486
  • Fax: 816-822-0490
Mailing address:
  • Phone: 816-822-8486
  • Fax: 816-822-0490

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: JANET L GORDON
Title or Position: ADMINISTRATOR
Credential: BS MBA
Phone: 816-822-8486