=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548586456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AKESO MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2010
-----------------------------------------------------
Last Update Date | 04/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10015 NW AMBASSADOR DR SUITE 100
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64153-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-595-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10015 NW AMBASSADOR DR SUITE 100
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64153-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-595-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF BUSINESS OPERATIONS
-----------------------------------------------------
Name | DR. DEBRA ELIZABETH MARDIS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 816-582-1157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 2008036747
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------