Provider Demographics
NPI:1528053543
Name:NILL, DAVID T (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:NILL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2901 ROCKCREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64117-2536
Mailing Address - Country:US
Mailing Address - Phone:816-201-2273
Mailing Address - Fax:816-571-6215
Practice Address - Street 1:2901 ROCKCREEK PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64117-2536
Practice Address - Country:US
Practice Address - Phone:816-201-2273
Practice Address - Fax:816-571-6215
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MOMD 110354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20-877577-01Medicaid
MOF84549Medicare UPIN
KS20-877577-01Medicaid