Provider Demographics
NPI:1790704831
Name:AMIRI, MOHSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:
Last Name:AMIRI
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 1:901 W MEM DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2475
Mailing Address - Country:US
Mailing Address - Phone:816-404-5700
Mailing Address - Fax:
Practice Address - Street 1:2211 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2733
Practice Address - Country:US
Practice Address - Phone:816-404-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015021072084P0800X
MO1040092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209808419Medicaid
KS100292320CMedicaid