| Shawnee Mission Internal Medicine Llc | |
|
11661 College Blvd Ste 100 Overland Park KS 66210-4104 | |
| (913) 954-8500 | |
| Not Available |
| Full Name | Shawnee Mission Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11661 College Blvd Ste 100, Overland Park, Kansas |
| Authorized Official Name and Position | Michelle Benkhadra (CREDENTIALIER) |
| Authorized Official Contact | 9139548500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawnee Mission Internal Medicine Llc 11661 College Blvd Ste 100 Overland Park KS 66210-4104 Ph: () - | Shawnee Mission Internal Medicine Llc 11661 College Blvd Ste 100 Overland Park KS 66210-4104 Ph: (913) 954-8500 |
| NPI Number | 1720826548 |
|---|---|
| Provider Enumeration Date | 07/16/2024 |
| Last Update Date | 07/16/2024 |
| Medicare PECOS PAC ID | 5890226922 |
|---|---|
| Medicare Enrollment ID | O20241001000954 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720826548 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ammar X Khalifa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780677948 PECOS PAC ID: 9638062185 Enrollment ID: I20051115000302 |
| Provider Name | Shannon Ortman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710300074 PECOS PAC ID: 2668603804 Enrollment ID: I20140401000975 |
| Provider Name | April Maiyo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528717659 PECOS PAC ID: 1052707445 Enrollment ID: I20220412001757 |
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