Individual
MARCO S MAZZELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7201 E 147TH ST, GRANDVIEW, MO 64030-4204
(816) 416-4900
(816) 416-4901
Mailing address
3200 NE RALPH POWELL RD, LEES SUMMIT, MO 64064-2301
(816) 525-1600
(816) 525-0173
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0428890
KS
207RC0000X
Cardiovascular Disease Physician
Primary
2004017280
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033162219
—
MO
01
—
34436012
AETNA HMO
—
01
—
431092652
TRICARE CHAMPUS
—
01
—
7563574
AETNA
—
01
—
A030
AETNA PPO
—
01
—
P000149535
RAILROAD MEDICARE
—
01
—
P00853573
MEDICARE RAILROAD
MO
01
—
P01128616
RAILROAD MEDICARE
MO
Enumeration date
05/18/2006
Last updated
01/04/2022
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