Provider Demographics
NPI:1184617656
Name:MAZUREK, JULIANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:M
Last Name:MAZUREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:MAZUREK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 11157
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-0157
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:913-234-1108
Practice Address - Street 1:2800 CLAY EDWARDS DR
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3220
Practice Address - Country:US
Practice Address - Phone:816-346-7220
Practice Address - Fax:816-346-7242
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7P70207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203717210Medicaid
930042005OtherRR MEDICARE GROUP CD1534
MOP00785266OtherRR MEDICARE GROUP DP7386
MO17865079OtherBCBS KC GROUP 42676018
MO17865069OtherBCBS OF KC MO
MO17865069OtherBCBS OF KC MO
MO6780444Medicare PIN
MO17865079OtherBCBS KC GROUP 42676018