MEDICARE: DR. LAITH A AL MOMANI 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	207RG0100X	Gastroenterology Physician	0447621	KS
2	207RG0100X	Gastroenterology Physician	036159796	IL
3	207RG0100X	Gastroenterology Physician	2019024529	MO

General Provider Information

NPI Number	:	1740642065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAITH A AL MOMANI MD

Provider Business Mailing Address
First Line	:	901 E 104TH ST
Second Line	:	MAILSTOP 400S
City	:	KANSAS CITY
State	:	MO
Zip	:	64131
Country	:	US
Telephone Number	:	913-491-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4321 WASHINGTON ST STE 5100
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-5933
Country	:	US
Telephone Number	:	913-491-9100
Fax Number	:

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

Provider Enumeration Date	:	03/25/2016
Last Update Date	:	06/13/2023

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