Healthcare Provider Details

I. General information

NPI: 1770546483
Provider Name (Legal Business Name): FARID M NAMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FARID MEHDIZADEH NAMIN MD

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18640 E 38TH TER S
INDEPENDENCE MO
64057-2304
US

IV. Provider business mailing address

18640 E 38TH TER S
INDEPENDENCE MO
64057-2304
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-1191
  • Fax: 816-229-1198
Mailing address:
  • Phone: 816-229-1191
  • Fax: 816-229-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number04-30181
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2006009289
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2006009289
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: