Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 04-37406 | KS |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2009016025 | MO |
NPI | 1003050204 |
---|---|
Provider Name | Dr. Michael Jonathan Khadavi |
First Address | Overland Park, KS 66211 |
Second Address | Overland Park, KS 66211-1330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2009 |
Last Update Date | 19/08/2021 |