Healthcare Provider Details

I. General information

NPI: 1992781157
Provider Name (Legal Business Name): PIERRE PODREBARAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR STE 500
NORTH KANSAS CITY MO
64116-3243
US

IV. Provider business mailing address

5101 COLLEGE BLVD
LEAWOOD KS
66211-1614
US

V. Phone/Fax

Practice location:
  • Phone: 816-468-8820
  • Fax: 816-468-8898
Mailing address:
  • Phone: 816-478-4200
  • Fax: 816-875-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number04-26208
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1999140782
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: