Provider Demographics
NPI:1104917715
Name:POMPUSHKO, ROSALIE (MD)
Entity type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:
Last Name:POMPUSHKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 WORNALL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1417
Mailing Address - Country:US
Mailing Address - Phone:816-333-9965
Mailing Address - Fax:
Practice Address - Street 1:6143 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-1417
Practice Address - Country:US
Practice Address - Phone:816-333-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5E982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC52174Medicare UPIN
MO0005424Medicare ID - Type Unspecified