Healthcare Provider Details

I. General information

NPI: 1861649303
Provider Name (Legal Business Name): KASHIF ASHFAQ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SUMMERLON CIR STE B
DODGE CITY KS
67801-2905
US

IV. Provider business mailing address

2200 SUMMERLON CIR STE B
DODGE CITY KS
67801-2905
US

V. Phone/Fax

Practice location:
  • Phone: 162-430-6723
  • Fax: 844-220-3758
Mailing address:
  • Phone: 620-371-5252
  • Fax: 620-371-5126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberBP10040662
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberP67001
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number4301096032
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberK-04-36058
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: