Healthcare Provider Details

I. General information

NPI: 1912753575
Provider Name (Legal Business Name): CHILDREN'S MERCY - WILDWOOD PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 NE LAKEWOOD WAY STE 100
LEES SUMMIT MO
64064-2058
US

IV. Provider business mailing address

4025 NE LAKEWOOD WAY STE 100
LEES SUMMIT MO
64064-2058
US

V. Phone/Fax

Practice location:
  • Phone: 816-287-8282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT D FINUF II
Title or Position: SNR VICE PRESIDENT
Credential:
Phone: 816-559-9370