Provider Demographics
NPI:1659541456
Name:VLACH, DAVID LEO (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEO
Last Name:VLACH
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 1:8109 N COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-5107
Mailing Address - Country:US
Mailing Address - Phone:816-516-3770
Mailing Address - Fax:816-741-0723
Practice Address - Street 1:1115 E PENCE RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-8804
Practice Address - Country:US
Practice Address - Phone:816-632-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD1042752084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208902718Medicaid
MO8097992Medicare PIN
MOG72309Medicare UPIN