MEDICARE: RADWAN AJLAN 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	207W00000X	Ophthalmology Physician	258770	MA
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	04-39850	KS

General Provider Information

NPI Number	:	1528476389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADWAN AJLAN M.D.

Provider Business Mailing Address
First Line	:	7400 STATE LINE RD STE 202
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3445
Country	:	US
Telephone Number	:	913-588-6606
Fax Number	:	913-588-0888

Provider Business Practice Location Address
First Line	:	4000 CAMBRIDGE ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-5306
Country	:	US
Telephone Number	:	913-588-1227
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	12/19/2024

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