MEDICARE: DR. JOSEPH THEODORE CERNICH 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	2080P0205X	Pediatric Endocrinology Physician	2003000631	MO
2	2080P0205X	Pediatric Endocrinology Physician	04-29903	KS

Other Identifiers

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

General Provider Information

NPI Number	:	1568412377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH THEODORE CERNICH M.D.

Provider Business Mailing Address
First Line	:	2401 GILLHAM RD
Second Line	:	ATTN PROVIDER ENROLLMENT DEPT
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-4619
Country	:	US
Telephone Number	:	816-701-5200
Fax Number	:	816-302-9939

Provider Business Practice Location Address
First Line	:	3101 BROADWAY BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2659
Country	:	US
Telephone Number	:	816-302-3700
Fax Number	:	816-302-9939

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	11/25/2025

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