MEDICARE: MOJTABA S OLYAEE 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	207RG0100X	Gastroenterology Physician	04-25364	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	663411	OTHER	KS	FIRSTGUARD
3	25934039	OTHER	MO	BCBS KC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548363450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOJTABA S OLYAEE M.D.

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD, RM 4035
Second Line	:	WESCOE MAILSTOP 1023
City	:	KANSAS CITY
State	:	KS
Zip	:	66160
Country	:	US
Telephone Number	:	913-588-6003
Fax Number	:	913-588-3975

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD, RM 4035
Second Line	:	WESCOE MAILSTOP 1023
City	:	KANSAS CITY
State	:	KS
Zip	:	66160
Country	:	US
Telephone Number	:	913-588-6000
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	05/28/2014

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Directions to “ MOJTABA S OLYAEE M.D.” Practice Location

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