Provider Demographics
NPI:1295777464
Name:ALBANI, JUSTIN M (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:ALBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 GLENN HENDREN DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-9602
Mailing Address - Country:US
Mailing Address - Phone:816-781-8400
Mailing Address - Fax:816-781-8263
Practice Address - Street 1:2529 GLENN HENDREN DR STE 202
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9602
Practice Address - Country:US
Practice Address - Phone:816-781-8400
Practice Address - Fax:816-781-8263
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006001742174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
36962024OtherBCBS KC
MOJ71A00018Medicare PIN
I40876Medicare UPIN