Basic Information
| Provider Information | |||||||||
| NPI: | 1568660389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAGADAN | ||||||||
| FirstName: | JULIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4440 BROADWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641113315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165310930 | ||||||||
| FaxNumber: | 8165312807 | ||||||||
| Practice Location | |||||||||
| Address1: | 4330 WORNALL RD STE 40 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641115940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165310930 | ||||||||
| FaxNumber: | 8165312807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9406874 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | 2015039924 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | 04-35874 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.