1205929775 NPI number — DR. OSSAMA W TAWFIK M.D.,PHD

Table of content: DR. OSSAMA W TAWFIK M.D.,PHD (NPI 1205929775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205929775 NPI number — DR. OSSAMA W TAWFIK M.D.,PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAWFIK
Provider First Name:
OSSAMA
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205929775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14425 COLLEGE BLVD STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66215-2317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-396-8509
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9705 LENEXA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENEXA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66215-1345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-396-8509
Provider Business Practice Location Address Fax Number:
913-495-9743
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  332929 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 04-24088 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 332929 . This is a "LOUISIANA LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 100145010A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18930018 . This is a "BCBS KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 627170 . This is a "FIRSTGUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 208617704 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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