Basic Information
| Provider Information | |||||||||
| NPI: | 1902919467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TADROS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 CAMBRIDGE ST STE G600 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661608501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135889600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4000 CAMBRIDGE ST STE G600 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661608501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135889600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 12/18/2018 | ||||||||
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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 | 207RC0000X | 106045 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 04-28224 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 106045 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | 04-28224 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 100338500B | 05 | KS | MEDICAID | 203934906 | 05 | MO | MEDICAID | 100338500A | 05 | KS | MEDICAID | 25756017 | 01 | MO | BCBS KC | OTHER | 055651 | 01 | KS | BCBS KS | OTHER |