Provider Demographics
NPI:1699411645
Name:MADAN, UJJWAL (MD)
Entity Type:Individual
Prefix:
First Name:UJJWAL
Middle Name:
Last Name:MADAN
Suffix:
Gender:F
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:UNIVERSITY HEALTH TRUMAN MEDICAL CENTER
Mailing Address - Street 2:2301 HOLMES ST.
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108
Mailing Address - Country:US
Mailing Address - Phone:816-404-4175
Mailing Address - Fax:816-404-0003
Practice Address - Street 1:2301 HOLMES STREET, UNIVERSITY HEALTH TRUMAN MEDICAL CE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-404-0957
Practice Address - Fax:816-404-0003
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO390200000X
MO2022016448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program