Provider Demographics
NPI:1043340094
Name:DANIEL R MROSAK MD PC
Entity Type:Organization
Organization Name:DANIEL R MROSAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MROSAK
Authorized Official - Suffix:
Authorized Official - Credentials:GENERAL SURGERY
Authorized Official - Phone:660-259-4383
Mailing Address - Street 1:PO BOX 932079
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64193-0001
Mailing Address - Country:US
Mailing Address - Phone:816-470-8952
Mailing Address - Fax:
Practice Address - Street 1:904 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2229
Practice Address - Country:US
Practice Address - Phone:816-470-8952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10001342100OtherCOMMUNITY HEALTH PLAN
MO000301100OtherFAMILY HEALTH PARTNERS
MOX070000Medicare PIN