Healthcare Provider Details

I. General information

NPI: 1073546578
Provider Name (Legal Business Name): BART C PATENAUDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E 54TH ST
KANSAS CITY MO
64110-2453
US

IV. Provider business mailing address

15 E 54TH ST
KANSAS CITY MO
64112-2861
US

V. Phone/Fax

Practice location:
  • Phone: 816-519-3013
  • Fax:
Mailing address:
  • Phone: 816-519-3013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number04-32490
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2008016031
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0432490
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: