Provider Demographics
NPI:1720613367
Name:MACAITIS, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MACAITIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 TROOST AVE STE 3400
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2666
Mailing Address - Country:US
Mailing Address - Phone:816-513-6243
Mailing Address - Fax:
Practice Address - Street 1:2400 TROOST AVE STE 3400
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2666
Practice Address - Country:US
Practice Address - Phone:816-513-6243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO020419-228791260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist