MEDICARE: ANATOLY LOSKUTOV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	2014014726	MO

General Provider Information

NPI Number	:	1184042525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANATOLY LOSKUTOV M.D.

Provider Business Mailing Address
First Line	:	4338 ROCKHILL RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-1543
Country	:	US
Telephone Number	:	913-634-7314
Fax Number	:

Provider Business Practice Location Address
First Line	:	4338 ROCKHILL RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-1543
Country	:	US
Telephone Number	:	913-634-7314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	08/01/2014

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