Provider Demographics
NPI:1861493934
Name:YAGAN, MARK B (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:YAGAN
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 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-9712
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 6000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-756-2255
Practice Address - Fax:816-931-4080
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR9N93207RC0200X, 207RP1001X
KS0425756207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0212774CMedicare PIN
KSW19A00041Medicare PIN
290001598Medicare PIN
0212774AMedicare PIN
104190Medicare PIN
0212774Medicare PIN
F30259Medicare UPIN
MOW19000070Medicare PIN
0212774Medicare PIN
KS104190OtherBCBS KS
F30259Medicare UPIN
KS10013060BMedicaid
MOW19000070Medicare PIN