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General NPI Number Information
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NPI Number | 1124557301
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Entity Type | Individual
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Provider Name | ETHAN ANDREW HACKER MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 2790 CLAY EDWARDS DR STE 520570
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116-3276
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Country | US
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Telephone | 816-221-6750
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Fax | 816-221-7280
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Provider Business Mailing Address
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Address Line | 2800 CLAY EDWARDS DRIVE, MEDICAL STAFF SERVICES
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116
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Country | US
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Telephone | 816-691-1655
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 94-09160
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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 | 35503
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 2025032202
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License Number State | MO
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