Healthcare Provider Details

I. General information

NPI: 1013036060
Provider Name (Legal Business Name): GHAITH NOAISEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 101ST TER
KANSAS CITY MO
64131-3366
US

IV. Provider business mailing address

3901 RAINBOW BLVD 5026 WESCOE, MS 2026
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 913-574-2438
  • Fax:
Mailing address:
  • Phone: 913-588-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2019024463
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: