Provider Demographics
NPI:1538168711
Name:REARDON, THOMAS M (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:REARDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2750 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 312
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3237
Mailing Address - Country:US
Mailing Address - Phone:816-453-4000
Mailing Address - Fax:816-842-1425
Practice Address - Street 1:2750 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 312
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-453-4000
Practice Address - Fax:816-842-1425
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR1F962086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2640491BMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
MOD93598Medicare UPIN