Provider Demographics
NPI:1205929775
Name:TAWFIK, OSSAMA W (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:OSSAMA
Middle Name:W
Last Name:TAWFIK
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14425 COLLEGE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2317
Mailing Address - Country:US
Mailing Address - Phone:913-396-8509
Mailing Address - Fax:
Practice Address - Street 1:9705 LENEXA DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1345
Practice Address - Country:US
Practice Address - Phone:913-396-8509
Practice Address - Fax:913-495-9743
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332929207ZP0102X
KS04-24088207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA332929OtherLOUISIANA LICENSE
KS100145010AMedicaid
MO18930018OtherBCBS KANSAS CITY
KS627170OtherFIRSTGUARD
MO208617704Medicaid