MEDICARE: SUHAIL ANSARI, MD, CHARTERED

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	225100000X	Physical Therapist
2	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	115607	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1225001530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUHAIL ANSARI, MD, CHARTERED

Provider Business Mailing Address
First Line	:	2138 N KANSAS AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2012
Country	:	US
Telephone Number	:	620-624-6222
Fax Number	:	620-624-5413

Provider Business Practice Location Address
First Line	:	2138 N KANSAS AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2012
Country	:	US
Telephone Number	:	620-624-6222
Fax Number	:	620-624-5413

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUHAIL ANSARI
Credential	:	MD
Telephone Number	:	620-624-6222

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/13/2019

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