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NPI Code Detail

MEDICARE: MIDTOWN FAMILY MEDICINE PC

MEDICARE: MIDTOWN FAMILY MEDICINE PC
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
1207Q00000XFamily Medicine Physician36683MO

General Provider Information

NPI Number : 1376784835
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDTOWN FAMILY MEDICINE PC
Provider Business Mailing Address
First Line : 3406 BROADWAY BLVD STE B
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-2767
Country : US
Telephone Number : 816-756-5839
Fax Number : 816-756-5874
Provider Business Practice Location Address
First Line : 3406 BROADWAY BLVD STE B
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-2767
Country : US
Telephone Number : 816-756-5839
Fax Number : 816-756-5874
Authorized Official
Title or Position : OFFICE MANAGER
Name : SUSAN DIEBOLD
Credential :
Telephone Number : 816-756-5839
Provider Enumeration Date : 03/13/2009
Last Update Date : 04/14/2021

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Directions to “MIDTOWN FAMILY MEDICINE PC ” Practice Location

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