Provider Demographics
NPI:1992781157
Name:PODREBARAC, PIERRE (MD)
Entity type:Individual
Prefix:
First Name:PIERRE
Middle Name:
Last Name:PODREBARAC
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 1:5101 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1614
Mailing Address - Country:US
Mailing Address - Phone:816-478-4200
Mailing Address - Fax:816-875-2598
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 500
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3243
Practice Address - Country:US
Practice Address - Phone:816-468-8820
Practice Address - Fax:816-468-8898
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26208207Y00000X
MO1999140782207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204822506Medicaid
MO204822506Medicaid
MA1639002Medicare PIN