Provider Demographics
NPI:1215914734
Name:JANTSCH, DEBORAH ANN (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:JANTSCH
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 1:825 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64124-2323
Mailing Address - Country:US
Mailing Address - Phone:816-474-4920
Mailing Address - Fax:816-889-1836
Practice Address - Street 1:825 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64124-2323
Practice Address - Country:US
Practice Address - Phone:816-474-4920
Practice Address - Fax:816-889-1836
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0435757207VG0400X
MOR4N05207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR4N05OtherMISSOURI BOARD OF HEALING ARTS
KS0435757OtherKANSAS BOARD OF HEALING ARTS
MO208257808Medicaid
MO208257808Medicaid
KS0435757OtherKANSAS BOARD OF HEALING ARTS