Basic Information
| Provider Information | |||||||||
| NPI: | 1528097722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARID | ||||||||
| FirstName: | REZA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843966 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738843300 | ||||||||
| FaxNumber: | 5738840943 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 W BUSINESS LOOP 70 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652033248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738840033 | ||||||||
| FaxNumber: | 5738840055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 110906 | MO | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 294836 | 01 | MO | HEALTHLINK | OTHER | 205205909 | 05 | MO | MEDICAID | 104665 | 01 | MO | BLUE SHIELD/BLUE CHOICE | OTHER | 2300073 | 01 | MO | UNITED HEALTHCARE | OTHER | 2087226901 | 01 | MO | KANSAS MEDICAID | OTHER |