Healthcare Provider Details

I. General information

NPI: 1902877921
Provider Name (Legal Business Name): ASSADOLLAH ZAINALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 15TH ST
LIBERAL KS
67901-2455
US

IV. Provider business mailing address

PO BOX 1024
WICHITA KS
67201-1024
US

V. Phone/Fax

Practice location:
  • Phone: 620-624-1651
  • Fax:
Mailing address:
  • Phone: 316-685-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number04-18506
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: