Provider Demographics
NPI:1154579415
Name:PLATZ, TRENT ANDREW (AA)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:ANDREW
Last Name:PLATZ
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 804408
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-4408
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:2525 GLENN HENDREN DR
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9625
Practice Address - Country:US
Practice Address - Phone:816-792-7037
Practice Address - Fax:816-792-7196
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2024-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2008025538367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1154579415Medicaid
MOP00639276OtherRR MEDICARE
MOP00639276OtherRR MEDICARE