Provider Demographics
NPI:1710913306
Name:VLASTOS, EMANUEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:J
Last Name:VLASTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:207 W GORE ST STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1014
Practice Address - Country:US
Practice Address - Phone:321-841-8555
Practice Address - Fax:321-841-2425
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118792207VM0101X
FLME154906207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO483444OtherHEALTHLINK
MO272121OtherGROUP HEALTHPLAN
MO2908754OtherCIGNA
MO5887070OtherAETNA
MO167050OtherBLUE CROSS BLUE SHIELD
MO205955602Medicaid
MO7400111OtherUNITED HEALTHCARE
MO7400111OtherUNITED HEALTHCARE
MO083012295Medicare ID - Type Unspecified