Healthcare Provider Details

I. General information

NPI: 1407598022
Provider Name (Legal Business Name): ZACHARY THOMAS SIRESS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5514 CORPORATE DR STE 120
SAINT JOSEPH MO
64507-7754
US

IV. Provider business mailing address

5514 CORPORATE DR STE 120
SAINT JOSEPH MO
64507-7754
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1350
  • Fax: 816-271-1355
Mailing address:
  • Phone: 816-271-1350
  • Fax: 816-271-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2025053213
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: