Healthcare Provider Details

I. General information

NPI: 1215501648
Provider Name (Legal Business Name): SHAHAB ALDIN SATTARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date: 04/22/2024
Reactivation Date: 05/03/2024

III. Provider practice location address

4401 WORNALL RD
KANSAS CITY MO
64111-3220
US

IV. Provider business mailing address

4401 WORNALL RD
KANSAS CITY MO
64111-3220
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: