MEDICARE: ASSADOLLAH ZAINALI 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	2085R0202X	Diagnostic Radiology Physician	04-18506	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	300022970	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	001282	OTHER	KS	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902877921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASSADOLLAH ZAINALI MD

Provider Business Mailing Address
First Line	:	PO BOX 1024
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67201-1024
Country	:	US
Telephone Number	:	316-685-6236
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 W 15TH ST
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2455
Country	:	US
Telephone Number	:	620-624-1651
Fax Number	:

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	12/02/2013

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