1710097357 NPI number — LEONARD JOHN LARSON II MD

Table of content: LEONARD JOHN LARSON II MD (NPI 1710097357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710097357 NPI number — LEONARD JOHN LARSON II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSON
Provider First Name:
LEONARD
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710097357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 SHAWNEE MISSION PKWY
Provider Second Line Business Mailing Address:
MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE 312
Provider Business Mailing Address City Name:
WESTWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66205-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-588-9000
Provider Business Mailing Address Fax Number:
913-588-9822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4810 STATE AVE
Provider Second Line Business Practice Location Address:
WYANDOTTE URGENT CARE
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102-1748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-321-4567
Provider Business Practice Location Address Fax Number:
913-321-6789
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  04-3170 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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