Healthcare Provider Details

I. General information

NPI: 1578517389
Provider Name (Legal Business Name): EDDIE R ISLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WORNALL RD SUITE 240
KANSAS CITY MO
64111-5941
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-4655
  • Fax: 816-932-7920
Mailing address:
  • Phone: 816-502-8755
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME95769
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2016022749
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number2016022749
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: