MEDICARE: DR. ATIYEH SAMADI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	9411736	KS

General Provider Information

NPI Number	:	1063113017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ATIYEH SAMADI

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD # MS 3016
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD # MS 3016
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-3124
Country	:	US
Telephone Number	:	913-588-3173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	06/13/2024

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