Provider Demographics
NPI:1194796441
Name:MALLOT, CORA A (MD)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:A
Last Name:MALLOT
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 1:7840 W 165TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3021
Mailing Address - Country:US
Mailing Address - Phone:913-373-2141
Mailing Address - Fax:913-373-2146
Practice Address - Street 1:7840 W 165TH ST STE 160
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3021
Practice Address - Country:US
Practice Address - Phone:913-373-2141
Practice Address - Fax:913-373-2146
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 2001013353207Q00000X
MO2001013353207Q00000X
KS0447050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH64768Medicare UPIN
MOP00355785Medicare PIN
MOK67B877Medicare PIN