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General NPI Number Information
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NPI Number | 1255522009
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Entity Type | Organization
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Legal Business Name | MIDWEST NEUROSCIENCE PC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 17020 E 40 HWY SUITE 8
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City | INDEPENDENCE
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State | MO
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Zip | 64055-5365
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Country | US
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Telephone | 816-373-3213
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Fax | 816-373-6209
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Provider Business Mailing Address
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Address Line | 17020 E 40 HWY SUITE 8
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City | INDEPENDENCE
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State | MO
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Zip | 64055-5365
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Country | US
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Telephone | 816-373-3213
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Fax | 816-373-6209
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHARLES D DONOHOE
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Credential | M.D.
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Telephone | 816-373-3213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R7396
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License Number State | MO
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