Provider Demographics
NPI:1194867291
Name:DANIEL K DANIELS
Entity Type:Organization
Organization Name:DANIEL K DANIELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KEBEDE
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-361-6777
Mailing Address - Street 1:6724 TROOST AVE STE 615
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1501
Mailing Address - Country:US
Mailing Address - Phone:816-361-6777
Mailing Address - Fax:816-361-5396
Practice Address - Street 1:6724 TROOST AVE STE 615
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1501
Practice Address - Country:US
Practice Address - Phone:816-361-6777
Practice Address - Fax:816-361-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7D15174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC50516Medicare UPIN
MO0005791Medicare ID - Type Unspecified