Basic Information
| Provider Information | |||||||||
| NPI: | 1811979776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHONEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10301 HICKMAN MILLS DR | ||||||||
| Address2: | 100 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641371674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167635446 | ||||||||
| FaxNumber: | 8167638426 | ||||||||
| Practice Location | |||||||||
| Address1: | 2316 E MEYER BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167635446 | ||||||||
| FaxNumber: | 8167638426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | R7A45 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 05-19187 | KS | N | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.