Provider Demographics
NPI:1144614041
Name:AKHTAR, EEMAN
Entity Type:Individual
Prefix:
First Name:EEMAN
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6265 ROCK CHALK DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5232
Mailing Address - Country:US
Mailing Address - Phone:785-842-5070
Mailing Address - Fax:785-505-5264
Practice Address - Street 1:6265 ROCK CHALK DR STE 1100
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5232
Practice Address - Country:US
Practice Address - Phone:785-842-5070
Practice Address - Fax:785-505-5264
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS04419432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program