Provider Demographics
NPI:1922033018
Name:WURTZ, MARY M (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:WURTZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4911 S ARROWHEAD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7005
Mailing Address - Country:US
Mailing Address - Phone:816-478-8113
Mailing Address - Fax:816-478-8108
Practice Address - Street 1:4911 S ARROWHEAD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7005
Practice Address - Country:US
Practice Address - Phone:816-478-8113
Practice Address - Fax:816-478-8108
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR8G42207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
73428017OtherBCBS KANSAS CITY
MO203414800Medicaid
MO203414800Medicaid
B373029AMedicare ID - Type Unspecified