Provider Demographics
NPI:1376746974
Name:TAGHIZADEH, SASCHA DARIUS (MD)
Entity Type:Individual
Prefix:
First Name:SASCHA
Middle Name:DARIUS
Last Name:TAGHIZADEH
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 1:6420 PROSPECT AVE
Mailing Address - Street 2:T-207
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4147
Mailing Address - Country:US
Mailing Address - Phone:816-276-9100
Mailing Address - Fax:816-276-9101
Practice Address - Street 1:6420 PROSPECT AVE
Practice Address - Street 2:T-207
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4147
Practice Address - Country:US
Practice Address - Phone:816-276-9100
Practice Address - Fax:816-276-9101
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1065048A207X00000X
MO2009007674207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200614500AMedicaid
MO1376746974Medicaid
BP2-0018484OtherINSTITUTIONAL PERMIT
MOP00737865Medicare PIN
KS200614500AMedicaid