NPI 1104354794

Blue Valley Dermatology LLC

Organisation Dermatology Physician Overland Park, KS

Practice location

Address: 7840 W 165th Street Suite 260, Overland Park, KS 66223
Phone: (415) 802-1310

Authorised official

Name: Tom Tkachuk
Title: Manager
Phone: (415) 802-1310

Registered specialties

Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207N00000X Licence 04-36968 (KS)

Other Dermatology providers in Kansas →

Registry record

NPI: 1104354794
Entity type: Organization
NPI issued: 26 May 2017
Record last updated: 25 Oct 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.