Provider Demographics
NPI:1306840012
Name:DANDAR, SAMUEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:L
Last Name:DANDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 6TH AVE
Mailing Address - Street 2:STE 320
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-3248
Mailing Address - Country:US
Mailing Address - Phone:913-651-6565
Mailing Address - Fax:913-772-8806
Practice Address - Street 1:1001 6TH AVE
Practice Address - Street 2:STE. 320
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3222
Practice Address - Country:US
Practice Address - Phone:913-651-6565
Practice Address - Fax:913-651-2087
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35072819207Q00000X
KS04-30685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG79976Medicare UPIN
KS105863Medicare PIN