| Mark Idstrom, MD | |
|
9100 W 74th St, Shawnee Mission, KS 66204-4004 | |
| (913) 676-2310 | |
| Not Available |
| Full Name | Mark Idstrom |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 50 Years |
| Location | 9100 W 74th St, Shawnee Mission, Kansas |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639264443 | NPI | - | NPPES |
| 15144081 | Other | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | R2J97 (Missouri) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| University Of Missouri Health Care | Columbia, MO | Hospital |
| Boone Hospital Center | Columbia, MO | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| The Curators Of The University Of Missouri | 4486759560 | 1035 |
| Entity Name | The Curators Of The University Of Missouri |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1235126921 PECOS PAC ID: 4486759560 Enrollment ID: O20070418000290 |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Idstrom, MD 9212 Nieman Rd, Overland Park, KS 66214-1868 Ph: (913) 599-6777 | Mark Idstrom, MD 9100 W 74th St, Shawnee Mission, KS 66204-4004 Ph: (913) 676-2310 |
Michael J Gaughan, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 9100 W 74th St, Shawnee Mission, KS 66204 Phone: 913-676-2310 | |
John Yungmeyer, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 9100 W 74th St, Shawnee Mission, KS 66204 Phone: 913-676-2310 | |
Jeffrey A Hicklin, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 9100 W 74th St, Shawnee Mission, KS 66204 Phone: 913-676-2310 | |
Richard D Miller, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 9100 W 74th St, Shawnee Mission, KS 66204 Phone: 913-676-2310 | |
Miss Kavita Chowdary Gorantla, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 9100 W 74th St, Shawnee Mission, KS 66204 Phone: 913-676-2310 | |
Michael W Dennis, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 9100 W 74th St, Shawnee Mission, KS 66204 Phone: 913-676-2310 | |
Mark S Reinsel, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 9100 W 74th St, Shawnee Mission, KS 66204 Phone: 913-599-6777 |