Provider Demographics
NPI:1255335196
Name:ANSARI, SUHAIL (MD)
Entity type:Individual
Prefix:DR
First Name:SUHAIL
Middle Name:
Last Name:ANSARI
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-0069
Mailing Address - Country:US
Mailing Address - Phone:620-624-6222
Mailing Address - Fax:620-624-5413
Practice Address - Street 1:2138 N KANSAS AVE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2012
Practice Address - Country:US
Practice Address - Phone:620-624-6222
Practice Address - Fax:620-624-5413
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428742207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100380740AMedicaid
KS102826OtherBCBS
KS100380740AMedicaid
KS102826Medicare ID - Type Unspecified