Individual
JOANITA IDICULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6675 HOLMES RD, SUITE 450, KANSAS CITY, MO 64131-1150
(816) 276-7650
Mailing address
6675 HOLMES RD, SUITE 450, KANSAS CITY, MO 64131-1150
(816) 276-7650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2015017265
MO
Other
Enumeration date
06/30/2015
Last updated
06/30/2015
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