Provider Demographics
NPI:1578785028
Name:MAALOUF, ROGER (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:MAALOUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MS 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8756
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:5844 NW BARRY RD
Practice Address - Street 2:STE 340
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154
Practice Address - Country:US
Practice Address - Phone:816-880-6238
Practice Address - Fax:816-880-2770
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011015509207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1578785028Medicaid
KS200666330AMedicaid
KS200666330AMedicaid