Provider Demographics
NPI:1114020617
Name:MD ELECTRODIAGNOSIS INC. P C
Entity type:Organization
Organization Name:MD ELECTRODIAGNOSIS INC. P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-361-8684
Mailing Address - Street 1:2330 E MEYER BLVD STE T107
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1140
Mailing Address - Country:US
Mailing Address - Phone:816-361-8684
Mailing Address - Fax:
Practice Address - Street 1:2330 E MEYER BLVD STE T107
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1140
Practice Address - Country:US
Practice Address - Phone:816-361-8684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOB18055Medicare UPIN