Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0214X | Pediatric Pulmonologist | 01064836 | IN |
N | 2080P0214X | Pediatric Pulmonologist | 0439109 | KS |
Y | 2080P0214X | Pediatric Pulmonologist | 2016017549 | MO |
NPI | 1144271651 |
---|---|
Provider Name | Dr. Baha'uddin Al-Shawwa |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 22/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200901530 | (05) | IN |
P01512407 | MEDICARE RR PTAN (01) | IN |