Basic Information
Provider Information
NPI: 1174780167
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHATTI
FirstName: IRFAN
MiddleName: SARWAR
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1800 COMMUNITY
Address2:  
City: CLINTON
State: MO
PostalCode: 647358804
CountryCode: US
TelephoneNumber: 6608908186
FaxNumber: 8163183001
Practice Location
Address1: 501 S SUNSET LN
Address2:  
City: RAYMORE
State: MO
PostalCode: 640839235
CountryCode: US
TelephoneNumber: 8884031071
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/19/2008
LastUpdateDate: 04/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0804X2013018203MON Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
2084P0800X2013018203MOY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

ID Information
IDTypeStateIssuerDescription
117478016705MO MEDICAID


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