Provider Demographics
NPI:1396211678
Name:PEDIATRIC DERMATOLOGY OF KANSAS CITY
Entity Type:Organization
Organization Name:PEDIATRIC DERMATOLOGY OF KANSAS CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-228-2000
Mailing Address - Street 1:2001 SHAWNEE MISSION PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:MISSION WOODS
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2060
Mailing Address - Country:US
Mailing Address - Phone:913-228-2000
Mailing Address - Fax:855-354-0963
Practice Address - Street 1:2001 SHAWNEE MISSION PKWY
Practice Address - Street 2:
Practice Address - City:MISSION WOODS
Practice Address - State:KS
Practice Address - Zip Code:66205-2007
Practice Address - Country:US
Practice Address - Phone:913-339-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty