Provider Demographics
NPI:1881770469
Name:NAVATO, NICHOLAS A (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:NAVATO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:ANTONIO
Other - Last Name:NAVATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3445 S STATE ROUTE 291
Mailing Address - Street 2:SUITE 303
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2663
Mailing Address - Country:US
Mailing Address - Phone:816-373-8715
Mailing Address - Fax:816-795-9388
Practice Address - Street 1:3445 S STATE ROUTE 291
Practice Address - Street 2:SUITE 303
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2663
Practice Address - Country:US
Practice Address - Phone:816-373-8715
Practice Address - Fax:816-795-9388
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102395208100000X
KS05-27198208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS8004A0001OtherMEDICARE
MOMA 2398001OtherMEDICARE
MOG74091Medicare UPIN