Healthcare Provider Details

I. General information

NPI: 1255599395
Provider Name (Legal Business Name): CORINTH PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4967 NE GOODVIEW CIR STE B
LEES SUMMIT MO
64064-2493
US

IV. Provider business mailing address

4967 NE GOODVIEW CIR STE B
LEES SUMMIT MO
64064-2493
US

V. Phone/Fax

Practice location:
  • Phone: 816-461-3535
  • Fax: 816-461-8782
Mailing address:
  • Phone: 816-461-3535
  • Fax: 816-461-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000387
License Number StateMO

VIII. Authorized Official

Name: MRS. JUDITH A STENGER
Title or Position: CLINICAL MANAGER
Credential: CERT. SURGICAL TECH
Phone: 816-461-3535