Provider Demographics
NPI:1730260456
Name:BAKLANOV, DMITRI VICTOROVICH (MD)
Entity type:Individual
Prefix:
First Name:DMITRI
Middle Name:VICTOROVICH
Last Name:BAKLANOV
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 1:4330 WORNALL RD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5939
Mailing Address - Country:US
Mailing Address - Phone:816-931-1883
Mailing Address - Fax:816-756-3645
Practice Address - Street 1:4330 WORNALL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33627207RI0011X
MO2006015209207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00842647OtherRAILROAD MEDICARE
KSP00830052OtherRAILROAD MEDICARE
KS200603500AMedicaid
KSKA1021042OtherMEDICARE - CUSHING
MO1730260456Medicaid
KS200603500BMedicaid
KS200603500COtherMEDICAID - CUSHING
MO204578108Medicaid
KSKA2004002Medicare PIN
KSKA1021042OtherMEDICARE - CUSHING
MO204578108Medicaid
MOMA2491030Medicare PIN
KSKA1724002Medicare PIN