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General NPI Number Information
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NPI Number | 1033162219
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Entity Type | Individual
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Provider Name | MARCO S MAZZELLA MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 7201 E 147TH ST
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City | GRANDVIEW
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State | MO
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Zip | 64030-4204
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Country | US
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Telephone | 816-416-4900
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Fax | 816-416-4901
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Provider Business Mailing Address
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Address Line | 3200 NE RALPH POWELL RD
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2301
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Country | US
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Telephone | 816-525-1600
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Fax | 816-525-0173
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0428890
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2004017280
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License Number State | MO
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