Provider Demographics
NPI:1932170610
Name:RILEY, JOHN J IV (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:RILEY
Suffix:IV
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 NICHOLS RD
Mailing Address - Street 2:SUITE 174
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2000
Mailing Address - Country:US
Mailing Address - Phone:816-561-7388
Mailing Address - Fax:816-561-9921
Practice Address - Street 1:411 NICHOLS RD
Practice Address - Street 2:SUITE 174
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2000
Practice Address - Country:US
Practice Address - Phone:816-561-7388
Practice Address - Fax:816-561-9921
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO595213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00952949OtherRR MEDICARE
MO15276025OtherBCBSKC
MO1548234586Medicaid
MO7981OtherCOVENTRY
MO7981OtherCOVENTRY
MO1548234586Medicaid
KSK900000AMedicare PIN