Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0440608 | KS |
NPI | 1114152121 |
---|---|
Provider Name | Firas I. Kawtharani |
First Address | Liberal, KS 67905-1215 |
Second Address | Liberal, KS 67901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 15/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0440608 | STATE LICENSE (01) | KS |
200761870A | (05) | OK |
201194750A | (05) | KS |