Provider Demographics
NPI:1881041549
Name:KANSAS CITY FAMILY ALLERGY,LLC
Entity Type:Organization
Organization Name:KANSAS CITY FAMILY ALLERGY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:F,
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DATTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-941-6400
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:SUITE 335
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4801
Mailing Address - Country:US
Mailing Address - Phone:816-941-6400
Mailing Address - Fax:816-941-6404
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 335
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4801
Practice Address - Country:US
Practice Address - Phone:816-941-6400
Practice Address - Fax:816-941-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100376207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty