MEDICARE: DR. JENNIFER L MORETINA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD2004016248	MO

General Provider Information

NPI Number	:	1053313627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER L MORETINA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 219658
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64121-9658
Country	:	US
Telephone Number	:	816-407-2300
Fax Number	:	816-407-2301

Provider Business Practice Location Address
First Line	:	8300 N CHURCH RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-1104
Country	:	US
Telephone Number	:	816-407-2300
Fax Number	:	816-407-2301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	09/15/2015

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