Healthcare Provider Details

I. General information

NPI: 1689661829
Provider Name (Legal Business Name): SUBBU JOSEPH SARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 NE LAKEWOOD WAY STE 210
LEES SUMMIT MO
64064-2059
US

IV. Provider business mailing address

4741 CENTRAL ST # 132
KANSAS CITY MO
64112-1533
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-7750
  • Fax: 816-554-7866
Mailing address:
  • Phone: 816-809-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number2003010751
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number04-31941
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: