Healthcare Provider Details

I. General information

NPI: 1295423028
Provider Name (Legal Business Name): ROSHAN BISARYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20375 W 151ST ST STE 301
OLATHE KS
66061-7207
US

IV. Provider business mailing address

20375 W 151ST ST STE 301
OLATHE KS
66061-7207
US

V. Phone/Fax

Practice location:
  • Phone: 913-445-4262
  • Fax: 913-956-0369
Mailing address:
  • Phone: 913-445-4262
  • Fax: 913-956-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-53384
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: