Healthcare Provider Details

I. General information

NPI: 1992941900
Provider Name (Legal Business Name): MUNAF SIYAMWALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S STE 310
INDEPENDENCE MO
64057-2306
US

IV. Provider business mailing address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

V. Phone/Fax

Practice location:
  • Phone: 913-222-9779
  • Fax: 816-698-7378
Mailing address:
  • Phone: 913-222-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME132055
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2011006608
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: