Provider Demographics
NPI:1558341347
Name:SALVAGGIO, BRUCE H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:SALVAGGIO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2330 SHAWNEE MISSION PARKWAY
Mailing Address - Street 2:MEDICAL ADMINISTRATIVE SERVICES OF KU STE. 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-0000
Mailing Address - Country:US
Mailing Address - Phone:913-945-5614
Mailing Address - Fax:913-945-5617
Practice Address - Street 1:10787 NALL AVE
Practice Address - Street 2:STE. 310
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-0000
Practice Address - Country:US
Practice Address - Phone:913-945-6900
Practice Address - Fax:913-945-6970
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR1A61207R00000X
KS04-33483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOSA201599107Medicaid
MOSA201599107Medicaid
MOD234665Medicare ID - Type Unspecified
MOC51833Medicare UPIN