Healthcare Provider Details

I. General information

NPI: 1316829724
Provider Name (Legal Business Name): RAMADAN RAKHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 SW STONE BRIDGE CT
LEES SUMMIT MO
64082-4076
US

IV. Provider business mailing address

2304 SW STONE BRIDGE CT
LEES SUMMIT MO
64082-4076
US

V. Phone/Fax

Practice location:
  • Phone: 913-290-2080
  • Fax:
Mailing address:
  • Phone: 913-290-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: