Provider Demographics
NPI:1407383870
Name:KERMANI, ATABAK ASVADI (MD)
Entity type:Individual
Prefix:DR
First Name:ATABAK
Middle Name:ASVADI
Last Name:KERMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ATABAK
Other - Middle Name:
Other - Last Name:ASVADI KERMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1800 S SWOPE DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3500 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5043
Practice Address - Country:US
Practice Address - Phone:913-680-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-46501207Q00000X
KS04-45327207QG0300X
MO2021045661207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine