Provider Demographics
NPI:1639119530
Name:VESCOVO, PAUL C JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:VESCOVO
Suffix:JR
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9000
Mailing Address - Fax:913-588-9822
Practice Address - Street 1:5601 N. ANTIOCH
Practice Address - Street 2:CREEKWOOD FAMILY CARE, STE. 12
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119
Practice Address - Country:US
Practice Address - Phone:816-452-8000
Practice Address - Fax:816-455-2382
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR1330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01887062OtherBCBS PROVIDER NUMBER
157695XXOtherPREFERRED CARE OF NY
481159444OtherTAX ID
MO110192165OtherRR MEDICARE NUMBER
2057250OtherAETNA
18960020OtherCFU BCBS NUMBER
2057250OtherAETNA
MOJ611900Medicare PIN