Healthcare Provider Details

I. General information

NPI: 1205456878
Provider Name (Legal Business Name): REWA ARAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S FREMONT AVE STE 2900
SPRINGFIELD MO
65804-2233
US

IV. Provider business mailing address

3901 BEAUBIEN ST RM 3T72
DETROIT MI
48201-2196
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-3535
  • Fax:
Mailing address:
  • Phone: 313-745-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023037143
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: