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General NPI Number Information
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NPI Number | 1396099016
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Entity Type | Individual
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Provider Name | JAMES MICHAEL LECLUYSE
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Gender | Male
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 222 W GREGORY BLVD STE 310
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City | KANSAS CITY
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State | MO
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Zip | 64114-1127
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Country | US
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Telephone | 816-916-7281
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Fax |
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Provider Business Mailing Address
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Address Line | 209 E 66TH TER
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City | KANSAS CITY
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State | MO
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Zip | 64113
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Country | US
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Telephone | 816-916-7281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 193400000X
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Taxonomy Name | Single Specialty Group
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License Number | 2002001828
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License Number State | MO
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