Provider Demographics
NPI:1972507705
Name:COATS, RICHARD D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:COATS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10730 NALL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1242
Mailing Address - Country:US
Mailing Address - Phone:913-754-2800
Mailing Address - Fax:913-754-2899
Practice Address - Street 1:4600 MEMORIAL DR
Practice Address - Street 2:STE. 240
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5368
Practice Address - Country:US
Practice Address - Phone:618-222-1020
Practice Address - Fax:618-222-1039
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002012294208600000X, 2086S0129X
KS04-40402208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128936Medicaid
MO209213602Medicaid
MOH91028Medicare UPIN
MO990101337Medicare PIN
MO209213602Medicaid
MOP00119903Medicare PIN