Provider Demographics
NPI:1366414492
Name:VANWYNGARDEN, TODD MARTIN (DPM)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:MARTIN
Last Name:VANWYNGARDEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 W 74TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-432-5052
Mailing Address - Fax:913-432-9990
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-432-5052
Practice Address - Fax:913-432-9990
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00245213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS480019065OtherMEDICARE RAILROAD
MO308097104Medicaid
U19268Medicare UPIN
B382989DMedicare ID - Type Unspecified