Healthcare Provider Details

I. General information

NPI: 1699886549
Provider Name (Legal Business Name): JAG M AGGARWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW MURRAY RD SUITE 306
LEES SUMMIT MO
64081-1204
US

IV. Provider business mailing address

5814 W 130TH ST
OVERLAND PARK KS
66209-3647
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-8400
  • Fax: 816-525-8411
Mailing address:
  • Phone: 913-897-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberR9D51
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: