Provider Demographics
NPI:1629173851
Name:DRAHOTA, LAWRENCE J (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:DRAHOTA
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:PO BOX 803968
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-3968
Mailing Address - Country:US
Mailing Address - Phone:913-541-3240
Mailing Address - Fax:913-492-0790
Practice Address - Street 1:11401 NALL AVE STE 216
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1850
Practice Address - Country:US
Practice Address - Phone:913-541-3240
Practice Address - Fax:913-492-0790
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS420267208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100207250AMedicaid
KSA876797Medicare ID - Type Unspecified