Healthcare Provider Details

I. General information

NPI: 1760794192
Provider Name (Legal Business Name): ANDRES MAURICIO VARGAS ESTRADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NE SAINT LUKES BLVD STE 240
LEES SUMMIT MO
64086-6019
US

IV. Provider business mailing address

1300 MEDICAL DR
TALLAHASSEE FL
32308-4646
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-1883
  • Fax:
Mailing address:
  • Phone: 850-216-0100
  • Fax: 850-309-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2025045209
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0451896
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: