Basic Information
Provider Information
NPI: 1922020395
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURNETT
FirstName: DAK
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5501 NW 62ND TER
Address2: SUITE 201
City: KANSAS CITY
State: MO
PostalCode: 641512408
CountryCode: US
TelephoneNumber: 8165848884
FaxNumber: 9139459612
Practice Location
Address1: 1530 N CHURCH RD
Address2:  
City: LIBERTY
State: MO
PostalCode: 640687129
CountryCode: US
TelephoneNumber: 8167811696
FaxNumber: 9139459611
Other Information
ProviderEnumerationDate: 07/24/2006
LastUpdateDate: 09/15/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XR2F31MOY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RC0000X04-19205KSN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

ID Information
IDTypeStateIssuerDescription
100172590B05KS MEDICAID
05155701KSBCBS KSOTHER
100172590A05KS MEDICAID
1169101201 BCBS KCOTHER
20218611005MO MEDICAID


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