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Individual
DR. SUSAN LEE DASTA
Active
Individual
DR. SUSAN LEE DASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2002019232
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851452635
—
MO
05
—
200587160A
—
KS
05
—
200587160B
—
KS
05
—
208318808
—
MO
01
—
31636039
BLUECROSS BLUESHIELD OF KANSAS CITY
—
Enumeration date
12/13/2006
Last updated
07/01/2016
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