MOHAN, PURNIMA SINGH (MD)

Provider Demographics

• NPI: 1275614505
• Name: MOHAN, PURNIMA SINGH (MD)
• Entity Type: Individual
• First Name: PURNIMA
• Middle Name: SINGH
• Last Name: MOHAN
• Gender: F
• Credentials: MD
• Mailing Address - Street 1: 17067 S OUTER RD
• Mailing Address - Street 2: SUITE 100
• Mailing Address - City: BELTON
• Mailing Address - State: MO
• Mailing Address - Zip Code: 64012-2165
• Mailing Address - Country: US
• Mailing Address - Phone: 816-331-4000
• Mailing Address - Fax: 816-331-2626
• Practice Address - Street 1: 17067 S OUTER RD
• Practice Address - Street 2: SUITE 100
• Practice Address - City: BELTON
• Practice Address - State: MO
• Practice Address - Zip Code: 64012-2165
• Practice Address - Country: US
• Practice Address - Phone: 816-331-4000
• Practice Address - Fax: 816-331-2626
• Is Sole Proprietor?: No
• Enumeration Date: 2006-10-17
• Last Update Date: 2014-11-03

Provider Licenses

State	License ID	Taxonomies
KS	04-32018	174400000X
MO	R7762	207Q00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine
No	174400000X	Other Service Providers	Specialist

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KS	200593720 A	Medicaid
KS	200593720 G	Medicaid
KS	200593720J	Medicaid
KS	200593720P	Medicaid
KS	200593720Q	Medicaid
KS	200593720 D	Medicaid
KS	200593720 F	Medicaid
KS	200593720K	Medicaid
KS	200593720 E	Medicaid
KS	200593720N	Medicaid
KS	200593720I	Medicaid
KS	200593720 B	Medicaid
KS	200593720 C	Medicaid
KS	200593720 H	Medicaid
MO	1275614505	Medicaid
MO	P09000002	Medicare PIN
MO	P14000002	Medicare PIN
MO	W01000004	Medicare PIN
MO	P00672416	Medicare PIN
MO	P00672406	Medicare PIN
MO	P00662336	Medicare PIN
MO	N96000002	Medicare PIN
MO	N88000001	Medicare PIN
MO	S28000001	Medicare PIN
MO	P00672420	Medicare PIN
KS	200593720 C	Medicaid
MO	P11000002	Medicare PIN
MO	P00679200	Medicare PIN
MO	P00672404	Medicare PIN
KS	200593720K	Medicaid
KS	200593720 E	Medicaid
KS	P01A00001	Medicare PIN
MO	P00672415	Medicare PIN
KS	200593720 H	Medicaid
KS	200593720N	Medicaid
KS	200593720I	Medicaid
MO	P00702006	Medicare PIN
MO	P01A00001	Medicare PIN
MO	P19000001	Medicare PIN
KS	200593720 G	Medicaid
KS	200593720 B	Medicaid
KS	200593720 A	Medicaid
MO	P01000001	Medicare PIN
MO	T37000003	Medicare PIN
MO	N87000001	Medicare PIN