MEDICARE: DR. ROBERT E TANENBAUM MD

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	207RC0000X	Cardiovascular Disease Physician	108594	MO

General Provider Information

NPI Number	:	1619976883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E TANENBAUM MD

Provider Business Mailing Address
First Line	:	901 E 104TH ST
Second Line	:	MAILSTOP 400S
City	:	KANSAS CITY
State	:	MO
Zip	:	64131
Country	:	US
Telephone Number	:	816-599-9261
Fax Number	:

Provider Business Practice Location Address
First Line	:	4330 WORNALL RD STE 2000
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-5939
Country	:	US
Telephone Number	:	816-931-1883
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/17/2020

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