Provider Demographics
NPI:1518909050
Name:STAECKER, HINRICH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HINRICH
Middle Name:
Last Name:STAECKER
Suffix:
Gender:M
Credentials:MD, PHD
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:KANSAS UNIVERSITY PHYSICIANS INC
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6701
Mailing Address - Fax:913-588-6708
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:KANSAS UNIVERSITY PHYSICIANS INC
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS300E053AMedicare ID - Type Unspecified
KSH02979Medicare UPIN