Provider Demographics
NPI:1871716472
Name:FOOT SPECIALISTS OF KANSAS CITY, P.A.
Entity type:Organization
Organization Name:FOOT SPECIALISTS OF KANSAS CITY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GEDULDIG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:913-677-3600
Mailing Address - Street 1:9119 W 74TH ST STE 352
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2229
Mailing Address - Country:US
Mailing Address - Phone:913-677-3600
Mailing Address - Fax:
Practice Address - Street 1:1956 NW COPPER OAKS CIR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8300
Practice Address - Country:US
Practice Address - Phone:816-228-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00598213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32555024OtherBLUE CROSS BLUE SHIELD MO
MON850000AMedicare ID - Type UnspecifiedPROVIDER ID