Healthcare Provider Details

I. General information

NPI: 1770586638
Provider Name (Legal Business Name): SYED M KHALID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S WHITNEY AVE # 200
INDEPENDENCE MO
64055-6765
US

IV. Provider business mailing address

17501 E 40 HWY STE 213A
INDEPENDENCE MO
64055-6445
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4887
  • Fax: 816-478-7222
Mailing address:
  • Phone: 816-478-4887
  • Fax: 816-478-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2002024523
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: