MEDICARE: DR. MARK ALON MANDELBAUM 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	2084N0400X	Neurology Physician	J9748	TX
2	2084N0400X	Neurology Physician	04-20041	KS
3	2084N0400X	Neurology Physician	2014036763	MO

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	:	1629033428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALON MANDELBAUM MD

Provider Business Mailing Address
First Line	:	4400 BROADWAY BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3498
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 BROADWAY
Second Line	:	STE. 520
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3498
Country	:	US
Telephone Number	:	816-531-4080
Fax Number	:	816-531-0281

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/04/2024

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Directions to “ DR. MARK ALON MANDELBAUM MD” Practice Location

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