Healthcare Provider Details

I. General information

NPI: 1154399475
Provider Name (Legal Business Name): ABHA KUMARI HAVALDAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 N WASHINGTON ST
CHILLICOTHEE MO
64601-2902
US

IV. Provider business mailing address

PO BOX 8657
SAINT JOSEPH MO
64508-8657
US

V. Phone/Fax

Practice location:
  • Phone: 660-214-8420
  • Fax:
Mailing address:
  • Phone: 816-866-5105
  • Fax: 816-207-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number111300
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: