Basic Information
| Provider Information | |||||||||
| NPI: | 1356549786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KCRCMD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3445 M 291 HWY #300 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167951968 | ||||||||
| FaxNumber: | 8167957045 | ||||||||
| Practice Location | |||||||||
| Address1: | 5201 JOHNSON DR | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662052908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167951968 | ||||||||
| FaxNumber: | 8167957045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | NAVATO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8167951968 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 04-22062 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.