Provider Demographics
NPI:1982725347
Name:DRISKO, JEANNETTE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:A
Last Name:DRISKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEANNETTE
Other - Middle Name:A
Other - Last Name:GLOTZBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 2028
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6208
Mailing Address - Fax:913-588-0012
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:4070 DELP MAIL STOP 4017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-208872085R0202X
MOR1F442085R0202X, 208D00000X
KS0420887208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32240017OtherBCBS KANSAS CITY
449510OtherFIRSTGUARD
MO32240017OtherBCBS KANSAS CITY
KS073C179AMedicare ID - Type Unspecified