Provider Demographics
NPI:1467414094
Name:MCDONNELL, JOSEPH F (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:MCDONNELL
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 1:600 ADMIRAL BLVD
Mailing Address - Street 2:#1905
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-1512
Mailing Address - Country:US
Mailing Address - Phone:620-719-6080
Mailing Address - Fax:
Practice Address - Street 1:22386 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-3148
Practice Address - Country:US
Practice Address - Phone:913-592-2409
Practice Address - Fax:913-592-2473
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2020-07-08
Deactivation Date:2018-06-13
Deactivation Code:
Reactivation Date:2020-07-08
Provider Licenses
StateLicense IDTaxonomies
KS04-30580207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH79057Medicare UPIN