Individual
PREMA FANCY D SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20300 E VALLEY VIEW PKWY, INDEPENDENCE, MO 64057
(816) 478-5200
(816) 302-9939
Mailing address
2401 GILLHAM RD, PROVIDER ENROLLMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2018028464
MO
Other
Enumeration date
05/22/2015
Last updated
08/21/2018
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