Provider Demographics
NPI:1285629931
Name:SPELL, ANGELA N (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:N
Last Name:SPELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 NW ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3973
Mailing Address - Country:US
Mailing Address - Phone:816-621-7700
Mailing Address - Fax:816-621-7707
Practice Address - Street 1:614 NW ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-3973
Practice Address - Country:US
Practice Address - Phone:816-621-7700
Practice Address - Fax:816-621-7707
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003003400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208364703Medicaid
F69C336Medicare ID - Type Unspecified
MO208364703Medicaid