=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467421016
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAGDY MONIR TADROS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2006
-----------------------------------------------------
Last Update Date | 08/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9318 W 146TH ST
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66221-2250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-685-4138
-----------------------------------------------------
Fax | 913-685-8140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25473
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66225-5473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-592-4560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0425748
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------