Provider Demographics
NPI:1730188418
Name:MAEDA, CHRIS JAMES (MD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:JAMES
Last Name:MAEDA
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 1:4320 WORNALL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3235
Mailing Address - Country:US
Mailing Address - Phone:816-931-2105
Mailing Address - Fax:816-931-0509
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3235
Practice Address - Country:US
Practice Address - Phone:816-931-2105
Practice Address - Fax:816-931-0509
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MOR8C98207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100117180AMedicaid
MO742006020OtherTAX ID #
MO13910016OtherMO BLUE SHIELD
MO201852910Medicaid
MOC51434Medicare UPIN
MO13910016OtherMO BLUE SHIELD