Healthcare Provider Details

I. General information

NPI: 1265886394
Provider Name (Legal Business Name): JOAN ANNIE CHANDRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 NE RALPH POWELL RD STE A
LEES SUMMIT MO
64064-2316
US

IV. Provider business mailing address

3601 NE RALPH POWELL RD STE A
LEES SUMMIT MO
64064-2316
US

V. Phone/Fax

Practice location:
  • Phone: 816-836-2200
  • Fax: 816-836-2244
Mailing address:
  • Phone: 816-836-2200
  • Fax: 816-836-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2022017167
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: