1639140288 NPI number — SHALINA D. GUPTA-BURT M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639140288 NPI number — SHALINA D. GUPTA-BURT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA-BURT
Provider First Name:
SHALINA
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURT
Provider Other First Name:
SHALINA
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639140288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11300 CORPORATE AVE
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:
66219-1374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-574-2800
Provider Business Mailing Address Fax Number:
913-574-2336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2750 CLAY EDWARDS DR LOWR LEVEL010
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-691-5216
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2006

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: 207RX0202X , with the licence number:  04-30933 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 04-30933 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 2004025511 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 209412303 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200277910I , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200277910C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200277910H , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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