Provider Demographics
NPI:1316906803
Name:CHIZARI, AZAM (ANP)
Entity type:Individual
Prefix:
First Name:AZAM
Middle Name:
Last Name:CHIZARI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 879985
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-0001
Mailing Address - Country:US
Mailing Address - Phone:913-248-9693
Mailing Address - Fax:913-248-9383
Practice Address - Street 1:1610 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-2842
Practice Address - Country:US
Practice Address - Phone:913-281-2605
Practice Address - Fax:913-281-0087
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000435363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427626007Medicaid
MO263D281AMedicare ID - Type UnspecifiedMEDICARE NUMBER