Organization
BLUE VALLEY DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM TKACHUK (MANAGER)
(415) 802-1310
Entity
Organization
Contact information
Practice address
7840 W 165TH STREET, SUITE 260, OVERLAND PARK, KS 66223
(415) 802-1310
Mailing address
7840 W 165TH STREET, SUITE 260, OVERLAND PARK, KS 66223
(415) 802-1310
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
04-36968
KS
Other
Enumeration date
05/26/2017
Last updated
10/25/2021
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