Healthcare Provider Details

I. General information

NPI: 1013359173
Provider Name (Legal Business Name): SAJJAD AHMAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 05/23/2019
Certification Date:
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

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

V. Phone/Fax

Practice location:
  • Phone: 816-271-1221
  • Fax: 816-279-7794
Mailing address:
  • Phone: 816-271-1221
  • Fax: 816-279-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2018038482
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: