Healthcare Provider Details

I. General information

NPI: 1730348541
Provider Name (Legal Business Name): PATRICIA DANDACHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NE SAINT LUKES BLVD SUITE 300
LEES SUMMIT MO
64086-6001
US

IV. Provider business mailing address

2340 E MEYER BLVD BLDG 2 SUITE 392
KANSAS CITY MO
64132-1105
US

V. Phone/Fax

Practice location:
  • Phone: 816-822-8486
  • Fax: 816-822-0490
Mailing address:
  • Phone: 816-822-8486
  • Fax: 816-822-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2011036697
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number04-35293
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier209578301
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 2
Identifier200973370A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: