MEDICARE: SUHAIL ANSARI 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	332B00000X	Durable Medical Equipment & Medical Supplies	0482742	KS

General Provider Information

NPI Number	:	1841332756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUHAIL ANSARI MD

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67905
Country	:	US
Telephone Number	:	620-624-6222
Fax Number	:	620-624-5413

Provider Business Practice Location Address
First Line	:	2138 N KANSAS AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2012
Country	:	US
Telephone Number	:	620-624-6222
Fax Number	:	620-624-5413

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUHAIL A ANSARI
Credential	:	MD
Telephone Number	:	620-624-6222

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	02/12/2019

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