# MIDTOWN FAMILY MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376784835
- **Authorized official:** SUSAN DIEBOLD (OFFICE MANAGER)
- **Authorized official phone:** (816) 756-5839

## Contact information

- **Practice address:** 3406 BROADWAY BLVD STE B, KANSAS CITY, MO 64111-2767
- **Practice address phone:** (816) 756-5839
- **Practice address fax:** (816) 756-5874
- **Mailing address:** 3406 BROADWAY BLVD STE B, KANSAS CITY, MO 64111-2767
- **Mailing address phone:** (816) 756-5839
- **Mailing address fax:** (816) 756-5874

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 36683 | MO | Yes |

## Other

- **Enumeration date:** 03/13/2009
- **Last updated:** 04/14/2021