MEDICARE: DR. SUSAN S PORTER MD

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
1	207L00000X	Anesthesiology Physician	R4199	MO
2	207L00000X	Anesthesiology Physician	0419151	KS

General Provider Information

NPI Number	:	1891743688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN S PORTER MD

Provider Business Mailing Address
First Line	:	828 W 56TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-1111
Country	:	US
Telephone Number	:	816-389-6030
Fax Number	:	816-389-6034

Provider Business Practice Location Address
First Line	:	3651 COLLEGE BLVD
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1904
Country	:	US
Telephone Number	:	816-389-6030
Fax Number	:	816-389-6034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. SUSAN S PORTER MD” Practice Location

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