Provider Demographics
NPI:1730113796
Name:DUPANOVIC, MIRSAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRSAD
Middle Name:
Last Name:DUPANOVIC
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:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-3315
Mailing Address - Fax:913-588-3365
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-3315
Practice Address - Fax:913-588-3365
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02410415Medicaid
NY00372225Medicaid
NY2222OtherBLUE SHIELD GROUP#
MDH506OtherPREFERRED CARE#
NYG0189393590OtherBLUE CHOICE GROUP#
NY00026573101OtherUNIVERA PROVIDER#
7995442OtherAETNA PROVIDER#
P010226079OtherBLUE CHOICE PROVIDER#
000922097001OtherBD WNY/HEALTHNOW#
NY16535AMedicare ID - Type UnspecifiedMEDICARE GROUP#
000922097001OtherBD WNY/HEALTHNOW#
7995442OtherAETNA PROVIDER#