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NPI Code Detail

MEDICARE: DAMON MICHAEL HEYBROCK M.D.

MEDICARE: DAMON MICHAEL HEYBROCK 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
1207Q00000XFamily Medicine Physician2006019875MO

General Provider Information

NPI Number : 1881702066
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMON MICHAEL HEYBROCK M.D.
Provider Business Mailing Address
First Line : 3931 HOLMES ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64110-1123
Country : US
Telephone Number : 816-531-0415
Fax Number :
Provider Business Practice Location Address
First Line : 2901 ROCKCREEK PKWY
Second Line :
City : KANSAS CITY
State : MO
Zip : 64117-2536
Country : US
Telephone Number : 816-201-6215
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2006
Last Update Date : 07/08/2007

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