Healthcare Provider Details

I. General information

NPI: 1215114509
Provider Name (Legal Business Name): BIPINCHANDRA AVASHIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 E FRONT ST
KANSAS CITY MO
64120-1356
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 816-241-0603
  • Fax: 816-241-6276
Mailing address:
  • Phone: 800-232-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2004009687
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: