Provider Demographics
NPI:1821312372
Name:KALA DANUSHKODI MD LLC
Entity Type:Organization
Organization Name:KALA DANUSHKODI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KALA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANUSHKODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-455-1313
Mailing Address - Street 1:2700 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3251
Mailing Address - Country:US
Mailing Address - Phone:816-455-1313
Mailing Address - Fax:816-455-1314
Practice Address - Street 1:2700 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 310
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3251
Practice Address - Country:US
Practice Address - Phone:816-455-1313
Practice Address - Fax:816-455-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002013878208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780640276OtherPROVIDER NPI
MO2002013878OtherPHYSICIAN LICENSE
MO205913817Medicaid
MOH63461Medicare UPIN
1780640276OtherPROVIDER NPI