Healthcare Provider Details

I. General information

NPI: 1922033018
Provider Name (Legal Business Name): MARY M WURTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/20/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 S ARROWHEAD DR SUITE 201
INDEPENDENCE MO
64055-7005
US

IV. Provider business mailing address

4911 S ARROWHEAD DR SUITE 201
INDEPENDENCE MO
64055-7005
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-8113
  • Fax: 816-478-8108
Mailing address:
  • Phone: 816-478-8113
  • Fax: 816-478-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberR8G42
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: