Basic Information
| Provider Information | |||||||||
| NPI: | 1720008295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HRABIK | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HRABIK | ||||||||
| OtherFirstName: | BRENT | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6675 HOLMES RD STE 360 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641311167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767600 | ||||||||
| FaxNumber: | 8162767992 | ||||||||
| Practice Location | |||||||||
| Address1: | 6675 HOLMES RD STE 360 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641311167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767600 | ||||||||
| FaxNumber: | 8162767992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 11/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-23129 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 36938 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103268 | 01 | KS | BC/BS OF KANSAS | OTHER | 175244 | 01 | KS | COVENTRY INSURANCE | OTHER | 04-23129 | 01 | KS | STATE MEDICAL LICENSE | OTHER | BH1795220 | 01 | KS | DEA CERTIFICATE | OTHER | 109954 | 01 | KS | HPK | OTHER | 100370580C | 05 | KS | MEDICAID |