Provider Demographics
NPI:1184717852
Name:NORTHLAND INTERNAL MEDICINE M.D.'S P.C.
Entity type:Organization
Organization Name:NORTHLAND INTERNAL MEDICINE M.D.'S P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-453-9232
Mailing Address - Street 1:6080 N. OAK TRAFFICWAY
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118
Mailing Address - Country:US
Mailing Address - Phone:816-453-9232
Mailing Address - Fax:816-455-2423
Practice Address - Street 1:6080 N. OAK TRAFFICWAY
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118
Practice Address - Country:US
Practice Address - Phone:816-453-9232
Practice Address - Fax:816-455-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty