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General NPI Number Information
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NPI Number | 1841476603
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Entity Type | Organization
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Legal Business Name | UROLOGY CHARTERED
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 2750 CLAY EDWARDS DR SUITE 604
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116
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Country | US
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Telephone | 816-561-7414
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Fax | 816-561-6130
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Provider Business Mailing Address
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Address Line | 6104 LOCKTON LANE
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City | FAIRWAY
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State | KS
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Zip | 66204
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Country | US
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Telephone | 816-931-0145
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Fax | 816-931-0145
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN DAKERS MITCHELL
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Credential | MD
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Telephone | 816-931-0145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 29188
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License Number State | MO
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