Provider Demographics
NPI:1720075492
Name:RESKIN, CHARLES MAX (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MAX
Last Name:RESKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5800 NW BARRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1493
Mailing Address - Country:US
Mailing Address - Phone:816-741-6820
Mailing Address - Fax:816-741-5315
Practice Address - Street 1:5800 NW BARRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1493
Practice Address - Country:US
Practice Address - Phone:816-741-6820
Practice Address - Fax:816-741-5315
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MODOR6656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO04993010OtherBLUE CROSS BLUE SHIELD
MOE48321Medicare UPIN
MO0003462Medicare ID - Type Unspecified