Provider Demographics
NPI:1073515367
Name:TROUT, AMY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LEE
Last Name:TROUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:STE 300
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2303
Mailing Address - Country:US
Mailing Address - Phone:816-478-0220
Mailing Address - Fax:816-795-3456
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:STE 300
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-478-0220
Practice Address - Fax:816-795-3456
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000150992174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204988703Medicaid
MOH29700Medicare UPIN
MO149A813Medicare ID - Type Unspecified