Provider Demographics
NPI:1912008525
Name:DATTEL, FREDERICK SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:SCOTT
Last Name:DATTEL
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 1:1004 CARONDELET DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4802
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 330
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4802
Practice Address - Country:US
Practice Address - Phone:816-941-6400
Practice Address - Fax:816-941-6404
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1003762080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100281970CMedicaid
MO208124610Medicaid
MO208124610Medicaid