Healthcare Provider Details

I. General information

NPI: 1114450913
Provider Name (Legal Business Name): DANIELLE ANNE THORNBURG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE ANNE SCHNEIDER

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

2401 GILLHAM RD PROVIDER ENROLLMENT DEPT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3000
  • Fax: 816-302-9939
Mailing address:
  • Phone: 816-234-3000
  • Fax: 816-302-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number04-4988
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number2024035863
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: