Provider Demographics
NPI:1922020395
Name:BURNETT, DAK R (MD)
Entity Type:Individual
Prefix:
First Name:DAK
Middle Name:R
Last Name:BURNETT
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 1:5501 NW 62ND TER
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2408
Mailing Address - Country:US
Mailing Address - Phone:816-584-8884
Mailing Address - Fax:913-945-9612
Practice Address - Street 1:1530 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-7129
Practice Address - Country:US
Practice Address - Phone:816-781-1696
Practice Address - Fax:913-945-9611
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2F31207RC0000X
KS04-19205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100172590BMedicaid
KS051557OtherBCBS KS
KS100172590AMedicaid
11691012OtherBCBS KC
MO202186110Medicaid
KS100172590BMedicaid
KS100172590AMedicaid
KS110330013Medicare PIN
MO060051108Medicare PIN
KS051557Medicare PIN
MO0385538EMedicare PIN
MO0385538AMedicare PIN
KS060062378Medicare PIN