MEDICARE: JESAL SURESH AMIN MD

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	207P00000X	Emergency Medicine Physician	S9254	TX
2	207P00000X	Emergency Medicine Physician	2018031830	MO

General Provider Information

NPI Number	:	1548793532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESAL SURESH AMIN MD

Provider Business Mailing Address
First Line	:	PO BOX 801143
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1143
Country	:	US
Telephone Number	:	573-331-5583
Fax Number	:	573-331-5079

Provider Business Practice Location Address
First Line	:	211 SAINT FRANCIS DR
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-5049
Country	:	US
Telephone Number	:	573-331-5110
Fax Number	:	573-335-4689

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/10/2026

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