Healthcare Provider Details

I. General information

NPI: 1366443665
Provider Name (Legal Business Name): JYOTI PANICKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 NW MCNARY CT
LEES SUMMIT MO
64086-4011
US

IV. Provider business mailing address

241 NW MCNARY CT
LEES SUMMIT MO
64086-4011
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-0064
  • Fax: 816-347-0593
Mailing address:
  • Phone: 816-347-0064
  • Fax: 816-347-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2017028829
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: