Basic Information
Provider Information | |||||||||
NPI: | 1598713901 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RAMZA | ||||||||
FirstName: | BRIAN | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 901 E 104TH ST | ||||||||
Address2: | MAILSTOP 400N | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641314517 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8165028782 | ||||||||
FaxNumber: | 8169329670 | ||||||||
Practice Location | |||||||||
Address1: | 4330 WORNALL RD | ||||||||
Address2: | SUITE 2000 | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641115939 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8169311883 | ||||||||
FaxNumber: | 8167563645 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2006 | ||||||||
LastUpdateDate: | 11/15/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 2001020601 | MO | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 2001020601 | MO | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
ID | Type | State | Issuer | Description | KA1021024 | 01 | KS | MEDICARE - CUSHING | OTHER | 100405960J | 05 | KS |   | MEDICAID | P00842634 | 01 | KS | RAILROAD MEDICARE | OTHER | P00842678 | 01 | MO | RAILROAD MEDICARE | OTHER | 100405960A | 05 | KS |   | MEDICAID | 100405960H | 05 | KS |   | MEDICAID | 100405960K | 05 | KS |   | MEDICAID | 206001109 | 05 | MO |   | MEDICAID |