Healthcare Provider Details

I. General information

NPI: 1912008525
Provider Name (Legal Business Name): FREDERICK SCOTT DATTEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 CARONDELET DR SUITE 330
KANSAS CITY MO
64114-4802
US

IV. Provider business mailing address

1004 CARONDELET DR SUITE 330
KANSAS CITY MO
64114-4802
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-6400
  • Fax: 816-941-6404
Mailing address:
  • Phone: 816-941-6400
  • Fax: 816-941-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number100376
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: