Provider Demographics
NPI:1790958791
Name:ZOOK, HEIDI LYNN (MD)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:LYNN
Last Name:ZOOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:LYNN
Other - Last Name:HUSETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-0340
Practice Address - Fax:816-932-3148
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009028453208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1790958791Medicaid
MOW19000097Medicare PIN
KSW19A00064Medicare PIN