Healthcare Provider Details

I. General information

NPI: 1962765982
Provider Name (Legal Business Name): SHAHZAD RAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 WASHINGTON ST SUITE 4000
KANSAS CITY MO
64111-5905
US

IV. Provider business mailing address

901 E 104TH ST MS 400N
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-3300
  • Fax: 816-932-5793
Mailing address:
  • Phone: 816-502-8752
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2014039229
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: