MEDICARE: DR. ROSALIE POMPUSHKO 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	2084P0800X	Psychiatry Physician	R5E98	MO

General Provider Information

NPI Number	:	1104917715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSALIE POMPUSHKO M.D.

Provider Business Mailing Address
First Line	:	6143 WORNALL RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-1417
Country	:	US
Telephone Number	:	816-333-9965
Fax Number	:

Provider Business Practice Location Address
First Line	:	6143 WORNALL RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-1417
Country	:	US
Telephone Number	:	816-333-9965
Fax Number	:

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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