Healthcare Provider Details

I. General information

NPI: 1659620532
Provider Name (Legal Business Name): BASEM KAYALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BAPTISTE DR
PAOLA KS
66071-1314
US

IV. Provider business mailing address

PO BOX 15694
LENEXA KS
66285-5694
US

V. Phone/Fax

Practice location:
  • Phone: 913-294-6615
  • Fax:
Mailing address:
  • Phone: 913-634-3540
  • Fax: 913-825-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number04-36922
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01071843A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: