Provider Demographics
NPI:1699976134
Name:DUDGEON, MAUREEN (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:DUDGEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 N OAK TRFY STE LL1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-691-1655
Mailing Address - Fax:
Practice Address - Street 1:2750 CLAY EDWARDS DR LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-691-2880
Practice Address - Fax:816-346-7869
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025030499207RH0002X
MO2009029449207R00000X
MO2006008025207RH0002X
KS0432358207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1699976134Medicaid
MOW19000047Medicare PIN