Provider Demographics
NPI:1710933825
Name:PERVEZ, ADEEL (MD)
Entity Type:Individual
Prefix:
First Name:ADEEL
Middle Name:
Last Name:PERVEZ
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 1:206 NW MOCK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2530
Mailing Address - Country:US
Mailing Address - Phone:816-416-8635
Mailing Address - Fax:816-416-8651
Practice Address - Street 1:206 NW MOCK AVE STE 200
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2530
Practice Address - Country:US
Practice Address - Phone:816-416-8633
Practice Address - Fax:816-416-8644
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013029752207RC0200X, 207RP1001X, 207RS0012X
PAMD425350207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2695847OtherBLUE SHIELD
PA237963F08Medicare PIN
I59552Medicare UPIN