Provider Demographics
NPI:1548586456
Name:AKESO MEDICAL LLC
Entity Type:Organization
Organization Name:AKESO MEDICAL LLC
Other - Org Name:AKESO PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MARDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-582-1157
Mailing Address - Street 1:10015 NW AMBASSADOR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1364
Mailing Address - Country:US
Mailing Address - Phone:816-595-4000
Mailing Address - Fax:
Practice Address - Street 1:10015 NW AMBASSADOR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1364
Practice Address - Country:US
Practice Address - Phone:816-595-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036747213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7043950001Medicare NSC