Healthcare Provider Details

I. General information

NPI: 1326051343
Provider Name (Legal Business Name): FARHANA QURATUL AIN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 QUIVIRA RD
OVERLAND PARK KS
66215-2306
US

IV. Provider business mailing address

10540 MARTY ST SUITE 100
OVERLAND PARK KS
66212-2551
US

V. Phone/Fax

Practice location:
  • Phone: 913-541-5000
  • Fax:
Mailing address:
  • Phone: 913-660-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-31934
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2006026293
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: