MEDICARE: PIERRE PODREBARAC 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	207Y00000X	Otolaryngology Physician	04-26208	KS
2	207Y00000X	Otolaryngology Physician	1999140782	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	:	1992781157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIERRE PODREBARAC MD

Provider Business Mailing Address
First Line	:	5101 COLLEGE BLVD
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1614
Country	:	US
Telephone Number	:	816-478-4200
Fax Number	:	816-875-2598

Provider Business Practice Location Address
First Line	:	2790 CLAY EDWARDS DR STE 500
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3243
Country	:	US
Telephone Number	:	816-468-8820
Fax Number	:	816-468-8898

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	07/30/2024

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Directions to “ PIERRE PODREBARAC MD” Practice Location

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