Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 00245 | KS |
NPI | 1366414492 |
---|---|
Provider Name | Todd Martin Vanwyngarden |
First Address | Shawnee Mission, KS 66204-2204 |
Second Address | Shawnee Mission, KS 66204-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 11/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
308097104 | (05) | MO |
480019065 | MEDICARE RAILROAD (01) | KS |
U19268 | (02) |