Healthcare Provider Details

I. General information

NPI: 1013980614
Provider Name (Legal Business Name): ANDREW SINCLAIR PAVLOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 NW GOODVIEW CIRCLE
LEES SUMMIT MO
64064
US

IV. Provider business mailing address

3340 NE RALPH POWELL RD SUITE B
LEES SUMMIT MO
64064-2368
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4200
  • Fax: 816-478-0507
Mailing address:
  • Phone: 816-875-2599
  • Fax: 816-875-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberR4J45
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: