=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891906012
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEEPA C UPADHYAYA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2007
-----------------------------------------------------
Last Update Date | 07/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 NE SAINT LUKE'S BLVD STE 240
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-931-1883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 E 104TH ST MAILSTOP 400S
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-502-7117
-----------------------------------------------------
Fax | 816-932-9670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 2014004836
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------