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NPI Code Detail

MEDICARE: SUMMER HEALTH MEDICAL GROUP OF KANSAS, P.A.

MEDICARE: SUMMER HEALTH MEDICAL GROUP OF KANSAS, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1134941420
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMMER HEALTH MEDICAL GROUP OF KANSAS, P.A.
Provider Business Mailing Address
First Line : 169 MADISON AVE STE 11579
Second Line :
City : NEW YORK
State : NY
Zip : 10016-5101
Country : US
Telephone Number : 908-312-3755
Fax Number :
Provider Business Practice Location Address
First Line : 302 E CARSON AVE FL 10
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-5905
Country : US
Telephone Number : 908-312-3755
Fax Number :
Authorized Official
Title or Position : HEAD OF MEDICAL GROUP
Name : LEO DAMASCO
Credential :
Telephone Number : 240-338-0567
Provider Enumeration Date : 10/28/2024
Last Update Date : 11/20/2024

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