Healthcare Provider Details

I. General information

NPI: 1336187939
Provider Name (Legal Business Name): GUASTELLO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WORNALL RD SUITE 512
KANSAS CITY MO
64111-5941
US

IV. Provider business mailing address

4320 WORNALL RD SUITE 512
KANSAS CITY MO
64111-5941
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-5663
  • Fax: 816-753-4701
Mailing address:
  • Phone: 816-753-5663
  • Fax: 816-753-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH R GUASTELLO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 816-753-5663