Provider Demographics
NPI:1083730501
Name:NASHATIZADEH, MUHAMMAD MAHDI (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:MAHDI
Last Name:NASHATIZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 QUIVIRA RD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2306
Mailing Address - Country:US
Mailing Address - Phone:913-599-3828
Mailing Address - Fax:913-599-3451
Practice Address - Street 1:10550 QUIVIRA RD
Practice Address - Street 2:SUITE 530
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-599-3828
Practice Address - Fax:913-599-3451
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-060202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1083730501Medicaid
KS200623770AMedicaid
MO1083730501Medicaid
KSY20000006Medicare PIN