Provider Demographics
NPI:1669720173
Name:KANSAS CITY METROPOLITAN PHYSICIAN ASSOCIATION
Entity type:Organization
Organization Name:KANSAS CITY METROPOLITAN PHYSICIAN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-842-4440
Mailing Address - Street 1:5501 NW 62ND TER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2411
Mailing Address - Country:US
Mailing Address - Phone:816-842-4440
Mailing Address - Fax:816-842-2301
Practice Address - Street 1:5501 NW 62ND TER
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2411
Practice Address - Country:US
Practice Address - Phone:816-842-4440
Practice Address - Fax:816-842-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3J97207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty