Healthcare Provider Details

I. General information

NPI: 1922426691
Provider Name (Legal Business Name): MANDI MENARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3171 NE CARNEGIE DR STE A
LEES SUMMIT MO
64064-3226
US

IV. Provider business mailing address

3171 NE CARNEGIE DRIVE, SUITE A
LEE'S SUMMIT MO
64064
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-2800
  • Fax: 816-525-4077
Mailing address:
  • Phone: 816-525-2800
  • Fax: 816-525-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2017023979
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: