Provider Demographics
NPI:1093704314
Name:DANGELO, JAMES ALFRED (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALFRED
Last Name:DANGELO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CARONDELET DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4673
Mailing Address - Country:US
Mailing Address - Phone:816-941-9030
Mailing Address - Fax:816-941-4416
Practice Address - Street 1:1000 CARONDELET DR STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:816-941-9030
Practice Address - Fax:816-941-4416
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM220000002OtherMEDICARE PTAN
MOM220000002OtherMEDICARE PTAN