Individual
KRISHNA MANEJ DIVADEENAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 NE MISSOURI RD, SUITE 302, LEES SUMMIT, MO 64086-4722
(816) 523-0103
(816) 361-6471
Mailing address
200 NE MISSOURI RD, SUITE 302, LEES SUMMIT, MO 64086-4722
(816) 523-0103
(816) 361-6471
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
04-28281
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100098010
—
KS
01
—
30445011
BCBS OF KC
—
Enumeration date
08/29/2006
Last updated
09/01/2011
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