Provider Demographics
NPI:1932144573
Name:DIMACHKIE, MAZEN M (MD)
Entity Type:Individual
Prefix:
First Name:MAZEN
Middle Name:M
Last Name:DIMACHKIE
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 1:2100 W 36TH AVE MS 2012
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-1088
Mailing Address - Country:US
Mailing Address - Phone:913-588-6970
Mailing Address - Fax:913-588-0673
Practice Address - Street 1:3599 RAINBOW BLVD # MS 2012
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2078
Practice Address - Country:US
Practice Address - Phone:913-588-6970
Practice Address - Fax:913-588-0673
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04323372084N0008X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG39450Medicare UPIN
TX84A034Medicare PIN