Provider Demographics
NPI:1831173541
Name:TAHIRKHELI, LAEEQ AZMAT (MD)
Entity type:Individual
Prefix:
First Name:LAEEQ
Middle Name:AZMAT
Last Name:TAHIRKHELI
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:CAMERON REGIONAL MEDICAL CENTER, INC.
Mailing Address - Street 2:1600 E EVERGREEN
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429
Mailing Address - Country:US
Mailing Address - Phone:816-632-2101
Mailing Address - Fax:816-649-3383
Practice Address - Street 1:214 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURG
Practice Address - State:MO
Practice Address - Zip Code:64477-1238
Practice Address - Country:US
Practice Address - Phone:816-930-2041
Practice Address - Fax:816-539-2866
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO785D501OtherMEDICARE PART B
MO2004019669OtherCERTIFICATE/LICENSE NUMBE
MO243332046Medicaid
MOP00182717OtherMEDICARE RAILROAD
MOP00182717OtherMEDICARE RAILROAD