Healthcare Provider Details

I. General information

NPI: 1023758083
Provider Name (Legal Business Name): JUSTIN DASTRUP DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLAY EDWARDS DR
NORTH KANSAS CITY MO
64116-3220
US

IV. Provider business mailing address

2750 CLAY EDWARDS DR STE 200A
NORTH KANSAS CITY MO
64116-3277
US

V. Phone/Fax

Practice location:
  • Phone: 877-840-6992
  • Fax: 913-495-3712
Mailing address:
  • Phone: 877-840-6992
  • Fax: 913-495-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2025001426
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2025001426
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: