MEDICARE: MEHBOOB I VORA DO LLC

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	207Q00000X	Family Medicine Physician	05-25872	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110871	OTHER	KS	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1710944145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEHBOOB I VORA DO LLC

Provider Business Mailing Address
First Line	:	1755 E 61ST ST N
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-1917
Country	:	US
Telephone Number	:	316-744-7405
Fax Number	:	316-744-7756

Provider Business Practice Location Address
First Line	:	1755 E 61ST ST N
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-1917
Country	:	US
Telephone Number	:	316-744-7405
Fax Number	:	316-744-7756

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MEHBOOB I VORA
Credential	:	DO
Telephone Number	:	316-744-7405

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	08/22/2020

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Directions to “MEHBOOB I VORA DO LLC ” Practice Location

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