Mohammed Haider Aldahan – Family Medicine Physician

Key facts

NPI: 1164044129
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 2019046478 (MO)
Practice address: 13013 Fuller Ave Ste a
Grandview, MO 64030-2687
Phone: (816) 214-5548
NPI assigned: May 13, 2020
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

The Medina Clinic, Incorporated Primary Care Clinic/Center · Grandview, MO · NPI 1073893046

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
2019046478	MO	MD	Family Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
The Medina Clinic, Incorporated		Past since May 17, 2020	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	2019046478	MO	Yes

Addresses

Primary practice location

13013 Fuller Ave Ste a
Grandview, MO 64030-2687

Mailing address

8 N Keene St Apt 73
Columbia, MO 65201-6600
Phone (402) 419-9576

Other providers in Grandview, MO

All providers in Grandview, MO · Family Medicine Physician in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.