Healthcare Provider Details

I. General information

NPI: 1730746801
Provider Name (Legal Business Name): JARED MICHAEL ROBL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR STE 520570
NORTH KANSAS CITY MO
64116-3276
US

IV. Provider business mailing address

2800 CLAY EDWARDS DR CENTRAL VERIFCATION OFFICE/PAYOR ENROLLMENT
NORTH KANSAS CITY MO
64116
US

V. Phone/Fax

Practice location:
  • Phone: 816-221-6750
  • Fax: 816-221-2335
Mailing address:
  • Phone: 816-691-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD-49855
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2026013582
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-11485
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: