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NPI Code Detail

MEDICARE: MELANIE SUSAN DOLEZAL PA-C

MEDICARE: MELANIE SUSAN DOLEZAL PA-C
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1891238937
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELANIE SUSAN DOLEZAL PA-C
Provider Business Mailing Address
First Line : 3027 PROSPECT AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64128-1530
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3027 PROSPECT AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64128-1530
Country : US
Telephone Number : 816-861-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2016
Last Update Date : 03/15/2017

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Directions to “ MELANIE SUSAN DOLEZAL PA-C” Practice Location

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