MEDICARE: SULTANA JAHAN M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	2005013752	MO

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

General Provider Information

NPI Number	:	1346294840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SULTANA JAHAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 843966
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64184-3966
Country	:	US
Telephone Number	:	573-884-3300
Fax Number	:	573-884-0943

Provider Business Practice Location Address
First Line	:	1000 W NIFONG BLVD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5615
Country	:	US
Telephone Number	:	573-884-1130
Fax Number	:	573-884-5936

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	09/02/2022

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