Provider Demographics
NPI:1881665081
Name:KO, TOMMY K (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:K
Last Name:KO
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 1:1004 CARONDELET DR STE 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4858
Mailing Address - Country:US
Mailing Address - Phone:816-942-4500
Mailing Address - Fax:816-941-4504
Practice Address - Street 1:1004 CARONDELET DR STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4858
Practice Address - Country:US
Practice Address - Phone:816-942-4500
Practice Address - Fax:816-941-4504
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27564207RP1001X
MOR2K66207RP1001X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100126160DMedicaid
MO202937827Medicaid
KSE112438BMedicare PIN
F08610Medicare UPIN
MOE112438Medicare PIN