Provider Demographics
NPI:1861998072
Name:CHUDA, ANGELA (DO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CHUDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NE SAINT LUKES BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6007
Mailing Address - Country:US
Mailing Address - Phone:816-347-5100
Mailing Address - Fax:816-347-5136
Practice Address - Street 1:20 NE SAINT LUKES BLVD STE 350
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6007
Practice Address - Country:US
Practice Address - Phone:816-347-5100
Practice Address - Fax:816-347-5136
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2020040162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program