Healthcare Provider Details

I. General information

NPI: 1467502021
Provider Name (Legal Business Name): LAURIE D RIDDELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8781 N PLATTE PURCHASE DR
KANSAS CITY MO
64155
US

IV. Provider business mailing address

8781 N PLATTE PURCHASE DR
KANSAS CITY MO
64155
US

V. Phone/Fax

Practice location:
  • Phone: 816-587-3200
  • Fax: 816-587-7644
Mailing address:
  • Phone: 816-587-3200
  • Fax: 816-587-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36931
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: