Provider Demographics
NPI:1598858011
Name:KAUK, BRUCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:KAUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 N. OAK TRAFFICWAY
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5165
Mailing Address - Country:US
Mailing Address - Phone:816-453-9232
Mailing Address - Fax:816-455-2423
Practice Address - Street 1:6080 N. OAK TRAFFICWAY
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-5165
Practice Address - Country:US
Practice Address - Phone:816-453-9232
Practice Address - Fax:816-455-2423
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201036506Medicaid
D72747Medicare UPIN
MO201036506Medicaid
4074151Medicare PIN