Healthcare Provider Details

I. General information

NPI: 1912017278
Provider Name (Legal Business Name): TALKAD S RAGHUVEER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 MISSION WOODS RD
MISSION WOODS KS
66205-2008
US

IV. Provider business mailing address

3901 RAINBOW BLVD 4070 DELP MAIL STOP 4017
KANSAS CITY KS
66160-7816
US

V. Phone/Fax

Practice location:
  • Phone: 913-269-9415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number04-29244
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-29244
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: