Organization
KANSAS CITY PHLEBOLOGY MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN AMORUSO (SR VP REVENUE)
(847) 593-8460
Entity
Organization
Contact information
Practice address
10777 NALL AVE, #315, OVERLAND PARK, KS 66211-1362
(913) 345-2622
Mailing address
PO BOX 1602, NORTHBROOK, IL 60065-1602
(847) 593-8460
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
KS
2085R0204X
Vascular & Interventional Radiology Physician
—
KS
208600000X
Surgery Physician
Primary
—
KS
2086S0129X
Vascular Surgery Physician
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110132045
MEDICARE RAILROAD
KS
01
—
17430011
BLUE CROSS BLUE SHIELD OF KANSAS CITY
KS
Enumeration date
06/21/2006
Last updated
05/04/2023
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