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General NPI Number Information
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NPI Number | 1942278700
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Entity Type | Individual
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Provider Name | FARAHNAZ KOUSHA MD
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Gender | Female
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 17203 E 23RD ST S
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City | INDEPENDENCE
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State | MO
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Zip | 64057-1859
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Country | US
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Telephone | 816-478-5252
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Fax | 816-478-5251
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Provider Business Mailing Address
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Address Line | PO BOX 838
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City | SHAWNEE MISSION
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State | KS
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Zip | 66201-0838
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Country | US
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Telephone | 913-469-4244
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Fax | 913-469-1939
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2004034265
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30568
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License Number State | KS
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