Healthcare Provider Details

I. General information

NPI: 1538100318
Provider Name (Legal Business Name): ROZINA A. MOHIUDDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 RENNER RD KU MEDWEST
SHAWNEE KS
66217-9414
US

IV. Provider business mailing address

2330 SHAWNEE MISSION PKWY MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312
WESTWOOD KS
66205-2005
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-8400
  • Fax: 913-588-8413
Mailing address:
  • Phone: 913-588-9000
  • Fax: 913-588-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-26433
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10001637100
Identifier TypeOTHER
Identifier State
Identifier IssuerCHP PROVIDER NUMBER
# 2
Identifier1200924
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 3
Identifier157695XX
Identifier TypeOTHER
Identifier State
Identifier IssuerPREFERRED CARE NY
# 4
Identifier100304430B
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 5
Identifier327055
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRSTGUARD
# 6
Identifier24537042
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS
# 7
Identifier481159444
Identifier TypeOTHER
Identifier State
Identifier IssuerJAYHAWK TAX ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: