1306817648 NPI number — MELANIE L SMOLEN MD

Table of content: MELANIE L SMOLEN MD (NPI 1306817648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306817648 NPI number — MELANIE L SMOLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMOLEN
Provider First Name:
MELANIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YUEN
Provider Other First Name:
MELANIE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306817648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8550 MARSHALL DR STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66214-1505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-348-2260
Provider Business Mailing Address Fax Number:
913-495-3751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7201 E 147TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANDVIEW
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64030-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-348-2260
Provider Business Practice Location Address Fax Number:
913-495-3751
Provider Enumeration Date:
01/26/2006

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: 207Q00000X , with the licence number:  MD 110558 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 110558 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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