Provider Demographics
NPI:1376524298
Name:GONZALEZ, FEDERICO (MD)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N PARKER ST # 284
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3139
Mailing Address - Country:US
Mailing Address - Phone:913-660-4742
Mailing Address - Fax:913-204-1329
Practice Address - Street 1:23351 PRAIRIE STAR PKWY STE 125
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-6201
Practice Address - Country:US
Practice Address - Phone:913-676-8626
Practice Address - Fax:913-676-8649
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-12-06
Deactivation Date:2005-11-08
Deactivation Code:
Reactivation Date:2006-10-31
Provider Licenses
StateLicense IDTaxonomies
KS04262732086S0122X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100141250CMedicaid
KS1300066OtherUHC
4346992OtherAETNA
KS04-26273OtherKANSAS LICENSE
KS18975138OtherBLUE CROSS
B74810Medicare UPIN