Provider Demographics
NPI:1861453060
Name:HEBBAR, SUDARSHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDARSHAN
Middle Name:
Last Name:HEBBAR
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 1:6530 TROOST
Mailing Address - Street 2:STE A17
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-361-0670
Mailing Address - Fax:816-444-6936
Practice Address - Street 1:6530 TROOST
Practice Address - Street 2:STE A17
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131
Practice Address - Country:US
Practice Address - Phone:816-361-0670
Practice Address - Fax:816-444-6936
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107965207RN0300X
KS0425593207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E54560Medicare UPIN
1297739Medicare ID - Type Unspecified