Provider Demographics
NPI:1528054996
Name:NUNEZ, JULIAN JESUS (MD)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:JESUS
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 CORPORATE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7763
Mailing Address - Country:US
Mailing Address - Phone:816-271-1265
Mailing Address - Fax:816-271-4060
Practice Address - Street 1:5514 CORPORATE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7743
Practice Address - Country:US
Practice Address - Phone:816-271-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207005208Medicaid
MO1528054996Medicaid
KS200417980AMedicaid
KS200417980 CMedicaid
KSP00654739Medicare PIN
KS200417980 CMedicaid
MO1528054996Medicaid
MO207005208Medicaid
KS106033Medicare PIN
H46307Medicare UPIN