MEDICARE: DR. JOHN CLAYTON VERSTRAETE D.O.

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	207RI0200X	Infectious Disease Physician	111192	MO
2	207RI0200X	Infectious Disease Physician	05-28581	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110248445	OTHER	MO	RAILROAD MEDICARE PPG
3	440003964	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225092372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CLAYTON VERSTRAETE D.O.

Provider Business Mailing Address
First Line	:	3215 MAIN ST
Second Line	:	STE 100B
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2645
Country	:	US
Telephone Number	:	816-561-8125
Fax Number	:	816-931-8721

Provider Business Practice Location Address
First Line	:	3215 MAIN ST
Second Line	:	STE 100B
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2645
Country	:	US
Telephone Number	:	816-561-8125
Fax Number	:	816-931-8721

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	09/27/2013

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