Provider Demographics
NPI:1831161173
Name:BOWNIK, THADDEUS BRYAN (MD)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:BRYAN
Last Name:BOWNIK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9411 N OAK TRFY
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-436-7072
Mailing Address - Fax:816-436-2743
Practice Address - Street 1:2750 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 215
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-691-5400
Practice Address - Fax:816-346-7040
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR5809207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
05271050OtherBCBS OF KC INDIVIDUAL
MO202349809Medicaid
110128448OtherRAILROAD MEDICARE
MO202349809Medicaid
05271050OtherBCBS OF KC INDIVIDUAL