Provider Demographics
NPI:1467414094
Name:MCDONNELL, JOSEPH F (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26665 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7441
Mailing Address - Country:US
Mailing Address - Phone:168-062-5468
Mailing Address - Fax:
Practice Address - Street 1:4101 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5014
Practice Address - Country:US
Practice Address - Phone:913-682-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2024-05-08
Deactivation Date:2018-06-13
Deactivation Code:
Reactivation Date:2020-07-08
Provider Licenses
StateLicense IDTaxonomies
KS04-30580207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH79057Medicare UPIN