Healthcare Provider Details

I. General information

NPI: 1265659734
Provider Name (Legal Business Name): PODIATRY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 CARONDELET DR SUITE 480
KANSAS CITY MO
64114-4802
US

IV. Provider business mailing address

8901 W 74TH ST STE 200
SHAWNEE MISSION KS
66204-2204
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-7979
  • Fax:
Mailing address:
  • Phone: 913-432-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KERRI LYNN PATRICK
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 913-432-5052