Provider Demographics
NPI:1477669141
Name:EDALATI, DAVID D (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:EDALATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 W 121ST ST STE 106
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2009
Mailing Address - Country:US
Mailing Address - Phone:913-884-1055
Mailing Address - Fax:913-884-1066
Practice Address - Street 1:7011 W 121ST ST STE 106
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2009
Practice Address - Country:US
Practice Address - Phone:913-884-1055
Practice Address - Fax:913-884-1066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0424423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100143480CMedicaid
KSKA1865001Medicare Oscar/Certification
KS100143480CMedicaid