Basic Information
| Provider Information | |||||||||
| NPI: | 1336550938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHANEM | ||||||||
| FirstName: | YAZAN | ||||||||
| MiddleName: | MUNIR ELIAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 HOLMES STREET | ||||||||
| Address2: | TRUMAN MEDICAL CENTER - HH | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164044862 | ||||||||
| FaxNumber: | 8164044261 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 HOLMES ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164044175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2014 | ||||||||
| LastUpdateDate: | 08/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 2014014180 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.