Healthcare Provider Details

I. General information

NPI: 1407016694
Provider Name (Legal Business Name): SIVA KUMAR R. SOMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST STE G600
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

4000 CAMBRIDGE ST STE G600
KANSAS CITY KS
66160-8501
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-9600
  • Fax:
Mailing address:
  • Phone: 913-588-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number32513
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2024014228
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number04-48923
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number49811
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: