Provider Demographics
NPI:1639387582
Name:DASARI, ROSHAN (MBBS, MD, MPH)
Entity Type:Individual
Prefix:
First Name:ROSHAN
Middle Name:
Last Name:DASARI
Suffix:
Gender:M
Credentials:MBBS, MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 NW 59TH CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2172
Mailing Address - Country:US
Mailing Address - Phone:816-216-7932
Mailing Address - Fax:816-216-7932
Practice Address - Street 1:1700 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1182
Practice Address - Country:US
Practice Address - Phone:816-629-2743
Practice Address - Fax:816-629-2708
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9406405390200000X
IA386032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program