Healthcare Provider Details

I. General information

NPI: 1225001530
Provider Name (Legal Business Name): SUHAIL ANSARI, MD, CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 N KANSAS AVE
LIBERAL KS
67901-2012
US

IV. Provider business mailing address

2138 N KANSAS AVE
LIBERAL KS
67901-2012
US

V. Phone/Fax

Practice location:
  • Phone: 620-624-6222
  • Fax: 620-624-5413
Mailing address:
  • Phone: 620-624-6222
  • Fax: 620-624-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SUHAIL ANSARI
Title or Position: PRESIDENT
Credential: MD
Phone: 620-624-6222