Provider Demographics
NPI:1699729202
Name:BLICK, DAVID RICHARD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:BLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NW RD MIZE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014
Mailing Address - Country:US
Mailing Address - Phone:816-220-1117
Mailing Address - Fax:816-228-2053
Practice Address - Street 1:203 NW RD MIZE RD
Practice Address - Street 2:STE 200
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-220-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4J65207RC0000X, 207RI0011X
KS0422598207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005658218OtherAETNA
15073018OtherBLUE SHIELD OF KC HMO
0005658218OtherAETNA PPO
060014116OtherMEDICARE RAILROAD
0005658218OtherAETNA HMO
15073018OtherPHP FREEDOM
15073018OtherBLUE SHIELD OF KC PPO
MO1699729202Medicaid
431092652 A022OtherCHAMPUS TRICARE
0005658218OtherAETNA PPO
MO1699729202Medicaid
0005658218OtherAETNA HMO
15073018OtherBLUE SHIELD OF KC HMO
060014116OtherMEDICARE RAILROAD