Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME103041 | FL |
N | 208600000X | Surgeon | ME103041 | FL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 04-34294 | KS |
NPI | 1225221476 |
---|---|
Provider Name | Dr. Michelle De Souza |
First Address | Kansas City, MO 64141-1851 |
Second Address | Kansas City, KS 66160-8500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 08/04/2015 |