Provider Demographics
NPI:1619934684
Name:MODRCIN, ANN C (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:C
Last Name:MODRCIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3970
Mailing Address - Fax:816-983-6845
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3970
Practice Address - Fax:816-983-6845
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1018312081P0010X
KS04-241372081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100160730AMedicaid
MO203610613Medicaid
MO203610613Medicaid