Provider Demographics
NPI:1609979533
Name:GOLDSICH, JANA E (MD)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:E
Last Name:GOLDSICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:E
Other - Last Name:GOLDSICH-TERREROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:913-588-6670
Mailing Address - Fax:913-588-3365
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MAIL STOP 1034
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6670
Practice Address - Fax:913-588-3365
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30354207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100643620AMedicaid
MO32955011OtherBCBS KANSAS CITY
MO32955011OtherBCBS KANSAS CITY
D99453Medicare UPIN
617C623AMedicare ID - Type Unspecified
P00064943Medicare ID - Type UnspecifiedRAILROAD MEDICARE