Basic Information
Provider Information
NPI: 1134221385
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROCKFORD
FirstName: MELISSA
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BRICKMAN
OtherFirstName: MELISSA
OtherMiddleName: A
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 3901 RAINBOW BLVD
Address2: 4070 DELP MAIL STOP 4017
City: KANSAS CITY
State: KS
PostalCode: 66160
CountryCode: US
TelephoneNumber: 9135886670
FaxNumber: 9135883365
Practice Location
Address1: 3901 RAINBOW BLVD
Address2: MAIL STOP 1034
City: KANSAS CITY
State: KS
PostalCode: 66160
CountryCode: US
TelephoneNumber: 9135886670
FaxNumber: 9135883365
Other Information
ProviderEnumerationDate: 09/01/2006
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X04-31240KSY Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
92519801KSFIRSTGUARDOTHER
3537601101MOBCBS KANSAS CITYOTHER


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