Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2001003866 | MO |
NPI | 1003892787 |
---|---|
Provider Name | Kusai A Umran |
First Address | Mount Vernon, MO 65712-1004 |
Second Address | Mount Vernon, MO 65712-1004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 22/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205281801 | (05) | MO |
G56534 | (02) |