Healthcare Provider Details

I. General information

NPI: 1427026475
Provider Name (Legal Business Name): DANIEL RICHARD MROSAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 WOLLARD BLVD
RICHMOND MO
64085-2229
US

IV. Provider business mailing address

PO BOX 932079
KANSAS CITY MO
64193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 660-259-4383
  • Fax:
Mailing address:
  • Phone: 816-470-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR4D09
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: