Individual
DR. GOPICHAND PENDURTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
902 N RIVERSIDE RD, STE 200, SAINT JOSEPH, MO 64507-2518
(816) 271-1301
(816) 271-1302
Mailing address
902 N RIVERSIDE RD, STE 200, SAINT JOSEPH, MO 64507-2518
(816) 271-1301
(816) 271-1302
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
2016023070
MO
207RH0003X
Hematology & Oncology Physician
279764
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578798393
—
IA
05
—
1578798393
—
MO
05
—
201149740A
—
KS
01
—
P01795280
RR MEDICARE
MO
Enumeration date
05/22/2009
Last updated
05/08/2017
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