Basic Information
| Provider Information | |||||||||
| NPI: | 1013322080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THELEMAN | ||||||||
| FirstName: | CLAYTON | ||||||||
| MiddleName: | LEWIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 219672 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641219672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164074555 | ||||||||
| FaxNumber: | 8164072362 | ||||||||
| Practice Location | |||||||||
| Address1: | 2521 GLENN HENDREN DR STE 108 | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167813515 | ||||||||
| FaxNumber: | 8167813517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2014 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 12506876 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2019014000 | MO | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.