Healthcare Provider Details

I. General information

NPI: 1124076468
Provider Name (Legal Business Name): JEFFREY LEWIS HARSCH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N E WINDSOR DRIVE
LEE'S SUMMIT MO
64086-8477
US

IV. Provider business mailing address

1300 N.E. WINDSOR DR.
LEE'S SUMMIT MO
64086-8477
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-2405
  • Fax: 816-525-5559
Mailing address:
  • Phone: 816-525-2405
  • Fax: 816-525-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMO 498
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: