Provider Demographics
NPI:1821246562
Name:JALLU, SHAIS SHAFI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAIS
Middle Name:SHAFI
Last Name:JALLU
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 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-7000
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 6000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-756-2255
Practice Address - Fax:816-931-4080
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020747207RP1001X, 207RC0200X, 207RS0012X
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
NY390200000XOtherSTUDENT, HEALTH CARE