Healthcare Provider Details

I. General information

NPI: 1639387582
Provider Name (Legal Business Name): ROSHAN DASARI M.B.B.S, M.D., M.P.H
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 RAINBOW BLVD
EXCELSIOR SPRINGS MO
64024-1182
US

IV. Provider business mailing address

2005 NW 59TH CT
KANSAS CITY MO
64151-2172
US

V. Phone/Fax

Practice location:
  • Phone: 816-629-2743
  • Fax: 816-629-2708
Mailing address:
  • Phone: 816-216-7932
  • Fax: 816-216-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number9406405
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number38603
License Number StateIA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: