Basic Information
| Provider Information | |||||||||
| NPI: | 1902877921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAINALI | ||||||||
| FirstName: | ASSADOLLAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1024 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672011024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166856236 | ||||||||
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| Practice Location | |||||||||
| Address1: | 315 W 15TH ST | ||||||||
| Address2: | |||||||||
| City: | LIBERAL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 679012455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206241651 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2006 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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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 | 2085R0202X | 04-18506 | KS | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 100193280A | 05 | KS | MEDICAID | 001282 | 01 | KS | BCBS | OTHER | 300022970 | 01 | RAILROAD MEDICARE | OTHER | 0000U1995 | 05 | NM | MEDICAID | 100029640A | 05 | OK | MEDICAID |