Provider Demographics
NPI:1053347831
Name:HALBACH, DAVID P (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:HALBACH
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 1:12317 WENONGA LN
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1436
Mailing Address - Country:US
Mailing Address - Phone:913-400-3511
Mailing Address - Fax:
Practice Address - Street 1:12317 WENONGA LN
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1436
Practice Address - Country:US
Practice Address - Phone:913-400-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10001784000OtherCOMMUNITY HEALTH PLAN
KS200317660AMedicaid
MO209457506Medicaid
35021014OtherBLUE CROSS BLUE SHIELD KC
10001784000OtherCOMMUNITY HEALTH PLAN
MO209457506Medicaid
665D492AMedicare PIN