Provider Demographics
NPI:1285661835
Name:CLOUGH, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:CLOUGH
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:PO BOX 412892
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-2892
Mailing Address - Country:US
Mailing Address - Phone:816-942-0200
Mailing Address - Fax:816-942-0205
Practice Address - Street 1:5340 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1621
Practice Address - Country:US
Practice Address - Phone:816-942-0200
Practice Address - Fax:816-942-0205
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106552207T00000X
KS04-29963207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205104904Medicaid
KS100458340AOtherKS MEDICAID
MOP00353063OtherMEDICARE RR
MOW73A634OtherMEDICARE
KS100458340AOtherKS MEDICAID