Basic Information
Provider Information | |||||||||
NPI: | 1770546483 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NAMIN | ||||||||
FirstName: | FARID | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NAMIN | ||||||||
OtherFirstName: | FARID | ||||||||
OtherMiddleName: | MEHDIZADEH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 18640 E 38TH TER S | ||||||||
Address2: |   | ||||||||
City: | INDEPENDENCE | ||||||||
State: | MO | ||||||||
PostalCode: | 640572304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8162291191 | ||||||||
FaxNumber: | 8162291198 | ||||||||
Practice Location | |||||||||
Address1: | 18640 E 38TH TER S | ||||||||
Address2: |   | ||||||||
City: | INDEPENDENCE | ||||||||
State: | MO | ||||||||
PostalCode: | 640572304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8162291191 | ||||||||
FaxNumber: | 8162291198 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/11/2006 | ||||||||
LastUpdateDate: | 04/12/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/12/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 04-30181 | KS | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 2084P0800X | 2006009289 | MO | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 207RG0100X | 2006009289 | MO | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.