Healthcare Provider Details

I. General information

NPI: 1972928935
Provider Name (Legal Business Name): A4ME, PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
SHAWNEE MISSION KS
66204-4004
US

IV. Provider business mailing address

15400 LARSEN ST
OVERLAND PARK KS
66221-6807
US

V. Phone/Fax

Practice location:
  • Phone: 913-485-4139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number436887
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANIZA EHTESHAM
Title or Position: CERTIFYING OFFICER
Credential: MD
Phone: 913-485-4139