Healthcare Provider Details

I. General information

NPI: 1114126943
Provider Name (Legal Business Name): BRIAN PETER MIECZKOWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 01/28/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 PROSPECT AVE SUITE T303
KANSAS CITY MO
64132-4147
US

IV. Provider business mailing address

6420 PROSPECT AVE SUITE T303
KANSAS CITY MO
64132-4147
US

V. Phone/Fax

Practice location:
  • Phone: 816-333-1919
  • Fax: 816-333-2614
Mailing address:
  • Phone: 816-333-1919
  • Fax: 816-333-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3571 M31
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.009866
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2009-01056
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2014007846
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: