Provider Demographics
NPI:1891745014
Name:DEBROY, RENU (MD)
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:
Last Name:DEBROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NW R D MIZE RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2518
Mailing Address - Country:US
Mailing Address - Phone:816-220-9942
Mailing Address - Fax:816-220-9952
Practice Address - Street 1:205 NW R D MIZE RD
Practice Address - Street 2:SUITE 408
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2518
Practice Address - Country:US
Practice Address - Phone:816-220-9942
Practice Address - Fax:816-220-9952
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018218208100000X
KS04-31297208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
104845OtherBC/BS OF KS
481225035OtherUNITED HEALTHCARE
7450751OtherAETNA
357011OtherBC/BS OF KC
P00239678OtherRAILROAD RETIREMENT
7450751OtherAETNA
I34939Medicare UPIN
L75D893AMedicare PIN
P00239678OtherRAILROAD RETIREMENT
KS104845Medicare PIN