Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 2011002810 | MO |
NPI | 1194980409 |
---|---|
Provider Name | Dr. Jiten Natvar Lad |
First Address | Kansas City, MO 64105-2008 |
Second Address | Kansas City, MO 64105-2008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 24/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194980409 | (05) | MO |
45532016 | BLUE CROSS (01) | MO |