Organization
BLUE RIVER MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEAN MUNDHENKE M.D. (PRESIDENT)
(816) 373-3006
Entity
Organization
Contact information
Practice address
4911 S ARROWHEAD DR, SUITE 101, INDEPENDENCE, MO 64055-7005
(816) 373-3006
(816) 373-3087
Mailing address
4911 S ARROWHEAD DR, SUITE 101, INDEPENDENCE, MO 64055-7005
(816) 373-3006
(816) 373-3087
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151111
AETNA
MO
01
—
168067
COVENTRY
MO
01
—
32939018
BLUE CROSS BLUE SHIELD
MO
Enumeration date
12/29/2006
Last updated
10/10/2008
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