Provider Demographics
NPI:1366428625
Name:RASTORFER, SUZANNE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:RASTORFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:5808 W 110TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2504
Practice Address - Country:US
Practice Address - Phone:816-696-8000
Practice Address - Fax:816-302-9939
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-48012208000000X
AL35080208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-48012OtherSTATE OF KANSAS
FLME85687OtherSTATE OF FLORIDA
AL35080OtherALABAMA BOARD OF MEDICAL EXAMINERS
FL240673OtherWELLCARE
FL7948582OtherAETNA
FL270823000Medicaid
FL46468ZMedicare PIN
FL2068754003OtherCIGNA