1730113796 NPI number — DR. MIRSAD DUPANOVIC M.D.

Table of content: DR. OMAR ALKOREK DMD (NPI 1841720075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730113796 NPI number — DR. MIRSAD DUPANOVIC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUPANOVIC
Provider First Name:
MIRSAD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730113796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 411851
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64141-1851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-588-3315
Provider Business Mailing Address Fax Number:
913-588-3365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 RAINBOW BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66160-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-588-3315
Provider Business Practice Location Address Fax Number:
913-588-3365
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  04-32817 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02410415 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00372225 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222 . This is a "BLUE SHIELD GROUP#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MDH506 . This is a "PREFERRED CARE#" identifier . This identifiers is of the category "OTHER".
  • Identifier: G0189393590 . This is a "BLUE CHOICE GROUP#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026573101 . This is a "UNIVERA PROVIDER#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7995442 . This is a "AETNA PROVIDER#" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010226079 . This is a "BLUE CHOICE PROVIDER#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000922097001 . This is a "BD WNY/HEALTHNOW#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110625100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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