| Carend Provider Group Of Kansas Pa | |
|
12022 Blue Valley Pkwy Ste 514 Overland Park KS 66213-2647 | |
| (708) 630-1534 | |
| Not Available |
| Full Name | Carend Provider Group Of Kansas Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 12022 Blue Valley Pkwy Ste 514, Overland Park, Kansas |
| Authorized Official Name and Position | Awss Nmn Zidan (PRESIDENT) |
| Authorized Official Contact | 7086301534 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carend Provider Group Of Kansas Pa 120222 Blue Valley Parkway Suite 514, Pmb 514 Overland Park KS 66213 Ph: (708) 630-1534 | Carend Provider Group Of Kansas Pa 12022 Blue Valley Pkwy Ste 514 Overland Park KS 66213-2647 Ph: (708) 630-1534 |
| NPI Number | 1386326387 |
|---|---|
| Provider Enumeration Date | 08/01/2023 |
| Last Update Date | 12/22/2023 |
| Certification Date | 10/24/2023 |
| Medicare PECOS PAC ID | 2961843198 |
|---|---|
| Medicare Enrollment ID | O20240517003388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386326387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Tracey Meyers Sondik |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134240369 PECOS PAC ID: 4183619109 Enrollment ID: I20040419001133 |
| Provider Name | Lilliam Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821375213 PECOS PAC ID: 3678836640 Enrollment ID: I20180920003242 |
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