Provider Demographics
NPI:1285684167
Name:NYACHOWE, PASCAL (MD)
Entity Type:Individual
Prefix:DR
First Name:PASCAL
Middle Name:
Last Name:NYACHOWE
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 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-8755
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4320 WORNALL RD STE 5320
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-932-2836
Practice Address - Fax:816-932-9868
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050398802086S0127X
VA0101256919208600000X, 2086S0102X, 2086S0127X
IL0361392482086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200136406Medicaid
MOG33993Medicare UPIN
MO200136406Medicaid
MOBN5141370OtherDEA
MO699151789OtherBNDD
MO203488OtherBCBS
764725OtherHEALTHLINK
AR160479001Medicaid
MO200136406Medicaid