Provider Demographics
NPI:1841296274
Name:VARDAKIS, GREGORY (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:VARDAKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:206 NW MOCK AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2530
Mailing Address - Country:US
Mailing Address - Phone:816-229-1191
Mailing Address - Fax:816-229-1198
Practice Address - Street 1:206 NW MOCK AVE
Practice Address - Street 2:STE 100
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2530
Practice Address - Country:US
Practice Address - Phone:816-229-1191
Practice Address - Fax:816-229-1198
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO102269207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF85740Medicare UPIN