Provider Demographics
NPI:1336118116
Name:NAZZARO, JULES M (MD)
Entity Type:Individual
Prefix:
First Name:JULES
Middle Name:M
Last Name:NAZZARO
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 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 3021
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-5129
Mailing Address - Fax:913-588-5337
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 3021
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-5129
Practice Address - Fax:913-588-5337
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77172207T00000X
KS04-32129207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200405920AMedicaid
KS009E838AMedicare PIN
MAF48460Medicare UPIN
KS200405920AMedicaid