Healthcare Provider Details

I. General information

NPI: 1710088786
Provider Name (Legal Business Name): JOHN A CILIBERTI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLAY EDWARDS DRIVE
NORTH KANSAS CITY MO
64116
US

IV. Provider business mailing address

1900 SWIFT #203 PO BOX 7391
NORTH KANSAS CITY MO
64116
US

V. Phone/Fax

Practice location:
  • Phone: 916-221-5050
  • Fax: 816-471-1247
Mailing address:
  • Phone: 816-221-5050
  • Fax: 816-471-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDOR5P60
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: