Healthcare Provider Details

I. General information

NPI: 1174586218
Provider Name (Legal Business Name): SUSAN M HERZBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN M SMITH MD

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 WORNALL RD RADIATION ONCOLOGY DEPT
KANSAS CITY MO
64111-3229
US

IV. Provider business mailing address

6601 WINCHESTER AVE SUITE 230
KANSAS CITY MO
64133-4677
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2575
  • Fax: 816-932-2344
Mailing address:
  • Phone: 816-313-2677
  • Fax: 816-313-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number102512
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number04-24196
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: