Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 0430705 | KS |
N | 207RN0300X | Nephrologist | 114014 | MO |
NPI | 1063470052 |
---|---|
Provider Name | Hussain Haideri |
First Address | Kansas City, MO 64116-3276 |
Second Address | Mt Pleasant, TX 75455-2338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 14/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100216770C | (05) | KS |
200357900A | (05) | KS |
200357900D | (05) | KS |
G70415 | (02) | KS |