Basic Information
| Provider Information | |||||||||
| NPI: | 1508063835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORREA | ||||||||
| FirstName: | JUAN CARLOS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10730 NALL AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137542800 | ||||||||
| FaxNumber: | 9137542899 | ||||||||
| Practice Location | |||||||||
| Address1: | 10730 NALL AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137542800 | ||||||||
| FaxNumber: | 9137542899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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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 | 390200000X | BS 5741663 | MO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | 0437333 | KS | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2012012809 | MO | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 2012012809 | MO | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 0437333 | KS | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.