Healthcare Provider Details

I. General information

NPI: 1922236728
Provider Name (Legal Business Name): KAILASH T PAWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

2401 GILLHAM ROAD
KANSAS CITY MO
64108
US

V. Phone/Fax

Practice location:
  • Phone: 917-679-7711
  • Fax:
Mailing address:
  • Phone: 913-696-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2012012481
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number04-36505
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: