Healthcare Provider Details

I. General information

NPI: 1679718209
Provider Name (Legal Business Name): TARIQ SUWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 QUIVIRA RD
LENEXA KS
66215-3902
US

IV. Provider business mailing address

4405 W 150TH ST
LEAWOOD KS
66224-9547
US

V. Phone/Fax

Practice location:
  • Phone: 816-281-5407
  • Fax:
Mailing address:
  • Phone: 313-920-4957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301088378
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2020038097
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: