Healthcare Provider Details

I. General information

NPI: 1720051220
Provider Name (Legal Business Name): JAMES BRYAN WOHLWEND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 N. OAK TRAFFICWAY
KANSAS CITY MO
64155
US

IV. Provider business mailing address

9405 N. OAK TRAFFICWAY
KANSAS CITY MO
64155
US

V. Phone/Fax

Practice location:
  • Phone: 816-412-2900
  • Fax: 816-412-2915
Mailing address:
  • Phone: 816-412-2900
  • Fax: 816-412-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-31262
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: