Provider Demographics
NPI:1033256961
Name:SREEKUMAR NAIR MD LLC
Entity Type:Organization
Organization Name:SREEKUMAR NAIR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SREEKUMAR
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-795-1881
Mailing Address - Street 1:4031 NE LAKEWOOD WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064
Mailing Address - Country:US
Mailing Address - Phone:816-795-1881
Mailing Address - Fax:816-795-1212
Practice Address - Street 1:4031 NE LAKEWOOD WAY
Practice Address - Street 2:STE 100
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-795-1881
Practice Address - Fax:816-795-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1050972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506054600Medicaid