Healthcare Provider Details

I. General information

NPI: 1992306187
Provider Name (Legal Business Name): FOOT DOCTORS OF KANSAS CITY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

IV. Provider business mailing address

224 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-4778
  • Fax: 816-525-5761
Mailing address:
  • Phone: 816-525-4778
  • Fax: 816-525-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JULIE A BOUDREAUX
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-525-4778