Healthcare Provider Details

I. General information

NPI: 1851336564
Provider Name (Legal Business Name): NORTHLAND CHEST CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR SUITE 402
LIBERTY MO
64068
US

IV. Provider business mailing address

2521 GLENN HENDREN DR SUITE 402
LIBERTY MO
64068-3388
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-8445
  • Fax: 816-781-8413
Mailing address:
  • Phone: 816-781-8445
  • Fax: 816-781-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMDR7E84
License Number StateMO

VIII. Authorized Official

Name: MICHAEL B LOGGAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 816-781-8445