=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669824199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRASANTH BABU SADARAM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2016
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5325 FARAON ST
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64506-3488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-271-6406
-----------------------------------------------------
Fax | 816-271-7986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5325 FARAON ST
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64506-3488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-271-6406
-----------------------------------------------------
Fax | 816-271-7986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 2025036087
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | E-12977
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 2025036087
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------