Idstrom, Mark
Idstrom, Mark is an individual health care provider with primary practice located at 9100 W 74Th St , Shawnee Mission KS 66204-4004. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Idstrom, Mark can be contacted via phone (913) 676-2310.Contact Information
Primary practice address
9100 W 74Th St
Shawnee Mission KS 66204-4004
Phone: (913) 676-2310
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | R2J97 | Missouri |
Profile Details
| NPI number | 1639264443 |
|---|---|
| LBN Legal business name | Idstrom, Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 4th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639264443 | NPPES |
| Other | 15144081 | BCBS |
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Gaughan, Michael J
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9100 W 74Th St , Shawnee Mission KS 66204-4004