Provider Demographics
NPI:1972928935
Name:A4ME, PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:A4ME, PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFYING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MANIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:EHTESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-485-4139
Mailing Address - Street 1:15400 LARSEN ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-6807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-485-4139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS436887261QP2300X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic