Provider Demographics
NPI:1225415649
Name:ANSARI, NOUSHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NOUSHIN
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 BALTIMORE AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3402
Mailing Address - Country:US
Mailing Address - Phone:316-990-5592
Mailing Address - Fax:
Practice Address - Street 1:10500 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2373
Practice Address - Country:US
Practice Address - Phone:913-599-3828
Practice Address - Fax:913-599-3451
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS94-100932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program