MEDICARE: DR. SUHAIL ANSARI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	0428742	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	102826	OTHER	KS	BCBS

General Provider Information

NPI Number	:	1255335196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUHAIL ANSARI MD

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67905-0069
Country	:	US
Telephone Number	:	620-624-6222
Fax Number	:	620-624-5413

Provider Business Practice Location Address
First Line	:	2138 N KANSAS AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2012
Country	:	US
Telephone Number	:	620-624-6222
Fax Number	:	620-624-5413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/12/2019

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Directions to “ DR. SUHAIL ANSARI MD” Practice Location

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