Provider Demographics
NPI:1740641455
Name:NTTR MEDICAL LLC
Entity type:Organization
Organization Name:NTTR MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADDAH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GHOSHEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-634-3540
Mailing Address - Street 1:9506 W 149TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-8202
Mailing Address - Country:US
Mailing Address - Phone:913-302-5188
Mailing Address - Fax:913-825-6358
Practice Address - Street 1:14433 W 86TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4178
Practice Address - Country:US
Practice Address - Phone:913-634-3540
Practice Address - Fax:913-825-6358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1023159522OtherINDIVIDUAL NPI
KSI43506Medicare UPIN