Provider Demographics
NPI:1740250778
Name:ESFANDYARI, TUBA (MD)
Entity type:Individual
Prefix:
First Name:TUBA
Middle Name:
Last Name:ESFANDYARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD, RM 4035
Mailing Address - Street 2:WESCOE MAILSTOP 1023
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6003
Mailing Address - Fax:913-588-3975
Practice Address - Street 1:3901 RAINBOW BLVD, RM 4035
Practice Address - Street 2:WESCOE MAILSTOP 1023
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45969207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN290412800Medicaid
MNP00106321Medicare ID - Type UnspecifiedRAILROAD
MN290412800Medicaid
MN100000532Medicare ID - Type Unspecified