Provider Demographics
NPI:1508835034
Name:NINA ARAKELOVA, MD, PC
Entity Type:Organization
Organization Name:NINA ARAKELOVA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAKELOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-787-6070
Mailing Address - Street 1:PO BOX 14143
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66285-4143
Mailing Address - Country:US
Mailing Address - Phone:913-634-3540
Mailing Address - Fax:913-825-6358
Practice Address - Street 1:8701 TROOST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-2767
Practice Address - Country:US
Practice Address - Phone:913-634-3540
Practice Address - Fax:913-825-6358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS38466016OtherBLUE SHIELD KANSAS CITY
MO501528509Medicaid
KSKA1399Medicare PIN
DD6361Medicare PIN
KS38466016OtherBLUE SHIELD KANSAS CITY