Basic Information
| Provider Information | |||||||||
| NPI: | 1457316515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVALAPUR | ||||||||
| FirstName: | RAGHUVARDHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10918 ELM AVENUE | ||||||||
| Address2: | CRITTTENTON CHILDRENS CENTER | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167656600 | ||||||||
| FaxNumber: | 8167674159 | ||||||||
| Practice Location | |||||||||
| Address1: | 10918 ELM AVENUE | ||||||||
| Address2: | CRITTTENTON CHILDRENS CENTER | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167656600 | ||||||||
| FaxNumber: | 8167674159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 2004014263 | MO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 0430478 | KS | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.