Provider Demographics
NPI:1336103134
Name:FEDER, JOEL MAURICE (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:MAURICE
Last Name:FEDER
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 1:3515 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2501
Mailing Address - Country:US
Mailing Address - Phone:816-753-5144
Mailing Address - Fax:816-753-0804
Practice Address - Street 1:4601 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64124
Practice Address - Country:US
Practice Address - Phone:816-753-5144
Practice Address - Fax:816-753-0804
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-16907207Q00000X
MOR7325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO57321013OtherBCBS
MO200031852Medicaid
KSC883904Medicare PIN
KSP00020642OtherMEDICARE RAILROAD PIN