Healthcare Provider Details

I. General information

NPI: 1043506389
Provider Name (Legal Business Name): ERIN ELIZABETH MCDANIEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW COMMERCE DR STE 102
LEES SUMMIT MO
64086-5883
US

IV. Provider business mailing address

701 NW COMMERCE DR STE 102
LEES SUMMIT MO
64086-5883
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-3646
  • Fax: 816-554-3607
Mailing address:
  • Phone: 816-554-3646
  • Fax: 816-554-3607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2014018652
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: