Basic Information
| Provider Information | |||||||||
| NPI: | 1184617656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAZUREK | ||||||||
| FirstName: | JULIANNE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAZUREK | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | M. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 11157 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641190157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132341350 | ||||||||
| FaxNumber: | 9132341108 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 CLAY EDWARDS DR | ||||||||
| Address2: | |||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163467220 | ||||||||
| FaxNumber: | 8163467242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 02/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | R7P70 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0005X | R7P70 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 203717210 | 05 | MO | MEDICAID | 930042005 | 01 | RR MEDICARE GROUP CD1534 | OTHER | P00785266 | 01 | MO | RR MEDICARE GROUP DP7386 | OTHER | 17865079 | 01 | MO | BCBS KC GROUP 42676018 | OTHER | 17865069 | 01 | MO | BCBS OF KC MO | OTHER |