Healthcare Provider Details

I. General information

NPI: 1255338075
Provider Name (Legal Business Name): CORNERSTONE PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 VILLAGE DR
SAINT JOSEPH MO
64506-2459
US

IV. Provider business mailing address

1419 VILLAGE DR
SAINT JOSEPH MO
64506-2459
US

V. Phone/Fax

Practice location:
  • Phone: 816-676-1600
  • Fax: 816-676-1611
Mailing address:
  • Phone: 816-676-1600
  • Fax: 816-676-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: DR. ROBERT B. STURDEVANT
Title or Position: PRESIDENT
Credential: D.O
Phone: 816-676-1600