Healthcare Provider Details

I. General information

NPI: 1225259385
Provider Name (Legal Business Name): GERMAN G KAMALOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5514 CORPORATE DR STE 150
SAINT JOSEPH MO
64507-7763
US

IV. Provider business mailing address

1500 DODSON AVE SUITE 60
FORT SMITH AR
72901-5182
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1265
  • Fax: 816-271-4060
Mailing address:
  • Phone: 479-709-7325
  • Fax: 479-709-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44869
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.099425
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE-8764
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberE-8764
License Number StateAR
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2020017657
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: