Provider Demographics
NPI:1902877921
Name:ZAINALI, ASSADOLLAH (MD)
Entity Type:Individual
Prefix:
First Name:ASSADOLLAH
Middle Name:
Last Name:ZAINALI
Suffix:
Gender:M
Credentials:MD
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 1024
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1024
Mailing Address - Country:US
Mailing Address - Phone:316-685-6236
Mailing Address - Fax:
Practice Address - Street 1:315 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-624-1651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-185062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100193280AMedicaid
KS001282OtherBCBS
300022970OtherRAILROAD MEDICARE
NM0000U1995Medicaid
OK100029640AMedicaid
B91035Medicare UPIN
KS105980Medicare PIN
KS001282OtherBCBS