Provider Demographics
NPI:1831296383
Name:KANSAS CITY DERMATOLOGY, P.A.
Entity Type:Organization
Organization Name:KANSAS CITY DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-541-3230
Mailing Address - Street 1:10600 QUIVIRA ROAD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215
Mailing Address - Country:US
Mailing Address - Phone:913-541-3230
Mailing Address - Fax:
Practice Address - Street 1:10600 QUIVIRA ROAD
Practice Address - Street 2:SUITE 430
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215
Practice Address - Country:US
Practice Address - Phone:913-541-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1890000Medicare PIN