Provider Demographics
NPI:1871514786
Name:VUSTAR, MIRJANA (MD)
Entity type:Individual
Prefix:
First Name:MIRJANA
Middle Name:
Last Name:VUSTAR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MIRJANA
Other - Middle Name:
Other - Last Name:VUSTAR- LEIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-2568
Practice Address - Fax:855-903-0985
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52021207L00000X
MO2015020993207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C520210Medicare ID - Type Unspecified
H42155Medicare UPIN