Provider Demographics
NPI:1972542314
Name:BUSS, MARY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BUSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:LIGHTFOOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-347-5600
Mailing Address - Fax:816-347-5674
Practice Address - Street 1:20 NE SAINT LUKES BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6001
Practice Address - Country:US
Practice Address - Phone:816-347-5600
Practice Address - Fax:816-347-5674
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004010995208M00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1972542314Medicaid
MOH74000020Medicare PIN