Provider Demographics
NPI:1689835084
Name:DEEPAK, BANGALORE V (MD)
Entity Type:Individual
Prefix:
First Name:BANGALORE
Middle Name:V
Last Name:DEEPAK
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 1:5209 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2042
Mailing Address - Country:US
Mailing Address - Phone:913-534-4266
Mailing Address - Fax:
Practice Address - Street 1:2330 E MEYER BLVD STE 509
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1177
Practice Address - Country:US
Practice Address - Phone:816-276-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010014104207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2023087Medicare PIN