Provider Demographics
NPI:1003253782
Name:ARSENAULT, ANDRE JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:JOEL
Last Name:ARSENAULT
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 1:5325 FARAON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3488
Mailing Address - Country:US
Mailing Address - Phone:816-271-6406
Mailing Address - Fax:816-271-7986
Practice Address - Street 1:5325 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3488
Practice Address - Country:US
Practice Address - Phone:816-271-6406
Practice Address - Fax:816-271-7986
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016023437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201147790AMedicaid
NE10026591700Medicaid
IA1003253782Medicaid
MO1003253782Medicaid
MOP01703873OtherRR MEDCIARE
MO1003253782Medicaid
MOMA4170111Medicare PIN