Healthcare Provider Details

I. General information

NPI: 1477517597
Provider Name (Legal Business Name): HEPATO-GASTROENTEROLOGY ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 W 109TH STREET SUITE 206
OVERLAND PARK KS
66211
US

IV. Provider business mailing address

4601 W 109TH STREET SUITE 206
OVERLAND PARK KS
66211
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-5770
  • Fax: 913-451-4953
Mailing address:
  • Phone: 913-451-5770
  • Fax: 913-451-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34217
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0415236
License Number StateKS

VIII. Authorized Official

Name: ASGHAR M CHAUDHARY
Title or Position: PRESIDENT
Credential: MD FACP FACG
Phone: 913-451-5770