MEDICARE: DR. JOHN A SPERTUS 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	207RC0000X	Cardiovascular Disease Physician	111506	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982603973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A SPERTUS M.D.

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	:	816-502-7117
Fax Number	:	816-932-9670

Provider Business Practice Location Address
First Line	:	4320 WORNALL RD
Second Line	:	SUITE 65
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-5941
Country	:	US
Telephone Number	:	816-932-6100
Fax Number	:	816-461-6586

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	11/16/2017

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