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General NPI Number Information
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NPI Number | 1285360404
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Entity Type | Organization
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Legal Business Name | WELLBODYKC, LLC
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 2111 E KANSAS CITY RD
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City | OLATHE
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State | KS
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Zip | 66061-7050
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Country | US
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Telephone | 913-220-5724
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Fax | 913-222-1907
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Provider Business Mailing Address
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Address Line | 14375 NW 63RD ST
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City | KANSAS CITY
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State | MO
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Zip | 64152-8701
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Country | US
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Telephone | 913-220-5724
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Fax | 913-222-1907
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDALL GOLDSTEIN
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Credential | DO
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Telephone | 913-220-5724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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