Provider Demographics
NPI:1548265960
Name:DEPAOLIS, DION CARLO (MD)
Entity type:Individual
Prefix:DR
First Name:DION
Middle Name:CARLO
Last Name:DEPAOLIS
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 1:604 S. BITTERSWEET LANE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2316 E MEYER BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1136
Practice Address - Country:US
Practice Address - Phone:913-239-0272
Practice Address - Fax:913-239-0273
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-290142085R0204X
MO20040341502085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205389307Medicaid
KS100385430AMedicaid
KS104364Medicare ID - Type Unspecified
MO205389307Medicaid
KS100385430AMedicaid
MOJ96B040BMedicare ID - Type Unspecified