Healthcare Provider Details

I. General information

NPI: 1215914734
Provider Name (Legal Business Name): DEBORAH ANN JANTSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

IV. Provider business mailing address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

V. Phone/Fax

Practice location:
  • Phone: 816-474-4920
  • Fax: 816-889-1836
Mailing address:
  • Phone: 816-474-4920
  • Fax: 816-889-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0435757
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR4N05
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: