MEDICARE: YONATAN GIZAW M.D.

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	207R00000X	Internal Medicine Physician	0439647	KS
2	207R00000X	Internal Medicine Physician	TRN20246	FL

General Provider Information

NPI Number	:	1063824068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YONATAN GIZAW M.D.

Provider Business Mailing Address
First Line	:	4000 CAMBRIDGE 6040 DELP MS 1020
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-0001
Country	:	US
Telephone Number	:	913-588-6005
Fax Number	:	913-588-3877

Provider Business Practice Location Address
First Line	:	4000 CAMBRIDGE 6040 DELP MS 1020
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-2304
Country	:	US
Telephone Number	:	913-588-6005
Fax Number	:

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

Provider Enumeration Date	:	05/24/2014
Last Update Date	:	04/24/2018

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Directions to “ YONATAN GIZAW M.D.” Practice Location

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