Healthcare Provider Details

I. General information

NPI: 1114596616
Provider Name (Legal Business Name): AMIRREZA FATEHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CHARLOTTE ST
KANSAS CITY MO
64108-2727
US

IV. Provider business mailing address

2101 CHARLOTTE ST
KANSAS CITY MO
64108-2727
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-0072
  • Fax: 816-404-9902
Mailing address:
  • Phone: 816-404-0072
  • Fax: 816-404-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number2025042679
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: