Healthcare Provider Details

I. General information

NPI: 1992794143
Provider Name (Legal Business Name): MARK T STIVERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 CLAY EDWARDS DR SUITE 420
NORTH KANSAS CITY MO
64116-3237
US

IV. Provider business mailing address

2750 CLAY EDWARDS DR SUITE 420
NORTH KANSAS CITY MO
64116-3237
US

V. Phone/Fax

Practice location:
  • Phone: 816-241-3338
  • Fax: 816-936-8118
Mailing address:
  • Phone: 816-241-3338
  • Fax: 816-936-8118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number35102
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number04-18667
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35102
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number04-18667
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: