Healthcare Provider Details

I. General information

NPI: 1932296555
Provider Name (Legal Business Name): LAUREL A BONDI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/13/2012
Certification Date:
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 Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number513
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: