Organization
UROLOGY CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN DAKERS MITCHELL MD (PRESIDENT)
(816) 931-0145
Entity
Organization
Contact information
Practice address
2750 CLAY EDWARDS DR, SUITE 604, NORTH KANSAS CITY, MO 64116
(816) 561-7414
(816) 561-6130
Mailing address
6104 LOCKTON LANE, FAIRWAY, KS 66204
(816) 931-0145
(816) 931-0145
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
29188
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8390000
MO INDIVIDUAL PROV NO
MO
01
—
8391226
MEDICARE GROUP PROV NUMBE
MO
Enumeration date
01/11/2008
Last updated
01/16/2008
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