Provider Demographics
NPI:1669023388
Name:KANSAS CITY PEDIATRIC CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:KANSAS CITY PEDIATRIC CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:816-584-0505
Mailing Address - Street 1:4150 N MULBERRY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-1764
Mailing Address - Country:US
Mailing Address - Phone:816-584-0505
Mailing Address - Fax:816-265-6333
Practice Address - Street 1:4150 N MULBERRY DR STE 150
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-1764
Practice Address - Country:US
Practice Address - Phone:816-584-0505
Practice Address - Fax:816-265-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty