Provider Demographics
NPI:1366624215
Name:D'AMICO, SUSANA (MD, FACE)
Entity Type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:MD, FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 WASHINGTON ST STE 6100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5901
Mailing Address - Country:US
Mailing Address - Phone:816-932-3470
Mailing Address - Fax:816-932-3492
Practice Address - Street 1:4321 WASHINGTON ST STE 6100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5901
Practice Address - Country:US
Practice Address - Phone:816-932-3470
Practice Address - Fax:816-932-3492
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018371207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100448490AMedicaid
MO205882202Medicaid
KS100448490AMedicaid
KS100448490AMedicaid