Provider Demographics
NPI:1366962839
Name:KADLEC, ERIC DANIEL (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DANIEL
Last Name:KADLEC
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 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-1000
Mailing Address - Country:US
Mailing Address - Phone:573-884-2912
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR.
Practice Address - Street 2:MA303, DC032.00
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212
Practice Address - Country:US
Practice Address - Phone:573-642-5911
Practice Address - Fax:573-642-3015
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017021147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine