Provider Demographics
NPI:1578785028
Name:MAALOUF, ROGER (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:MAALOUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:901 HEARTLAND RD STE 3800
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6201
Mailing Address - Country:US
Mailing Address - Phone:816-271-1346
Mailing Address - Fax:816-271-1344
Practice Address - Street 1:901 HEARTLAND RD STE 4840
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6202
Practice Address - Country:US
Practice Address - Phone:816-271-1346
Practice Address - Fax:816-271-1344
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011015509207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200666330AMedicaid
MO1578785028Medicaid
KS200666330AMedicaid