Provider Demographics
NPI:1669441531
Name:SENSENICH, GREGORY W (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:SENSENICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-3673
Mailing Address - Country:US
Mailing Address - Phone:660-646-0000
Mailing Address - Fax:660-646-5404
Practice Address - Street 1:861 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3673
Practice Address - Country:US
Practice Address - Phone:660-646-0000
Practice Address - Fax:660-646-5404
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8G84207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13396035OtherBLUE CROSS BLUE SHIELD KC
MO242414720Medicaid
MO107198OtherBLUE CROSS BLUE SHIELD MO
13396035OtherBLUE CROSS BLUE SHIELD KC
D41465Medicare UPIN
13396035OtherBLUE CROSS BLUE SHIELD KC