MEDICARE: MOHAMMAD HAERI MD, PHD

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1316364573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD HAERI MD, PHD

Provider Business Mailing Address
First Line	:	4000 CAMBRIDGE ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8501
Country	:	US
Telephone Number	:	913-588-1101
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 CAMBRIDGE ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-3411
Country	:	US
Telephone Number	:	913-588-1101
Fax Number	:

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

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	06/14/2023

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