Basic Information
| Provider Information | |||||||||
| NPI: | 1801864509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAD | ||||||||
| FirstName: | SIMA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 838 | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662010838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134694244 | ||||||||
| FaxNumber: | 9134691939 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 STATE ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640671107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602596862 | ||||||||
| FaxNumber: | 6602596804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 112372 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 49444 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.