Provider Demographics
NPI:1366414971
Name:WAHL, NAOMI (MD)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:WAHL
Suffix:
Gender:F
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:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5511
Practice Address - Fax:573-331-5512
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012016003207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN361R1WAOtherBLUE CROSS
MN361R1WAOtherCC SYSTEMS/BLUE PLUS
SDHP24640OtherHEALTHPARTNERS
IA0503706Medicaid
SD4260OtherDAKOTACARE
SD4995764OtherBLUE CROSS
SD6630360Medicaid
MO1366414971Medicaid
NE10025040700Medicaid
SD57105AD02OtherWPS TRICARE
MN939216500Medicaid
SD283761017548OtherPREFERRED ONE
SD768489OtherARAZ/ AMERICA'S PPO
SD0703687OtherMEDICA
SD23737OtherMIDLANDS CHOICE
SD25421OtherSANFORD HEALTH PLAN
IA38022OtherBLUE CROSS
SD23737OtherMIDLANDS CHOICE
MN939216500Medicaid
IA0503706Medicaid
MN160002412Medicare PIN