Provider Demographics
NPI:1770609216
Name:DONATO, MARIA LOURDES ILAGAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA LOURDES
Middle Name:ILAGAN
Last Name:DONATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 E TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64126-2400
Mailing Address - Country:US
Mailing Address - Phone:816-600-1816
Mailing Address - Fax:816-221-2690
Practice Address - Street 1:5811 E TRUMAN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64126-2400
Practice Address - Country:US
Practice Address - Phone:816-600-1816
Practice Address - Fax:816-221-2690
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080024072084N0400X
KS04-328152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1770609216Medicaid
KS200579970BMedicaid
MOP00655733Medicare PIN