Provider Demographics
NPI:1508947904
Name:INCIARDI, MARC F (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:F
Last Name:INCIARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:4070 DELP MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6800
Mailing Address - Fax:913-588-7899
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MAIL STOP 4032
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6800
Practice Address - Fax:913-588-7899
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-231342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS306430OtherFIRSTGUARD
MO10945052OtherBCBS KANSAS CITY
MO10945052OtherBCBS KANSAS CITY
C51361Medicare UPIN
P00268412Medicare ID - Type UnspecifiedRAILROAD MEDICARE