Provider Demographics
NPI:1689661829
Name:SARMA, SUBBU JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBBU
Middle Name:JOSEPH
Last Name:SARMA
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 1:4741 CENTRAL ST # 132
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1533
Mailing Address - Country:US
Mailing Address - Phone:816-809-1715
Mailing Address - Fax:
Practice Address - Street 1:4025 NE LAKEWOOD WAY STE 210
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2059
Practice Address - Country:US
Practice Address - Phone:816-554-7750
Practice Address - Fax:816-554-7866
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030107512084A0401X
KS04-319412084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208778704Medicaid
H73953Medicare UPIN
MO208778704Medicaid