Healthcare Provider Details

I. General information

NPI: 1154424745
Provider Name (Legal Business Name): TYLER F BRUNDIGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 N OAK TRFY
KANSAS CITY MO
64155-2233
US

IV. Provider business mailing address

9401 N OAK TRFY
KANSAS CITY MO
64155-2233
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-1230
  • Fax: 816-350-6801
Mailing address:
  • Phone: 816-478-1230
  • Fax: 816-350-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2002007672
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: