Provider Demographics
NPI:1124076468
Name:HARSCH, JEFFREY LEWIS (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEWIS
Last Name:HARSCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N.E. WINDSOR DR.
Mailing Address - Street 2:
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-8477
Mailing Address - Country:US
Mailing Address - Phone:816-525-2405
Mailing Address - Fax:816-525-5559
Practice Address - Street 1:1300 N E WINDSOR DRIVE
Practice Address - Street 2:
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-8477
Practice Address - Country:US
Practice Address - Phone:816-525-2405
Practice Address - Fax:816-525-5559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 498213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10134016OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
MO301869103Medicaid
MOP00315777OtherPALMETTO GBA-RAILROAD MEDICARE
MOP00315777OtherPALMETTO GBA-RAILROAD MEDICARE
MO1282760001Medicare NSC
MOT42441Medicare UPIN