Healthcare Provider Details

I. General information

NPI: 1164545281
Provider Name (Legal Business Name): NASIM AHMADIYEH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-0099
  • Fax: 816-404-5381
Mailing address:
  • Phone: 816-218-2523
  • Fax: 816-285-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number04-37553
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2017035457
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number230857
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: