Healthcare Provider Details

I. General information

NPI: 1649365537
Provider Name (Legal Business Name): CAROLE A. GUILLAUME MD, FAASM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 COLLEGE BLVD SUITE 103
OVERLAND PARK KS
66210-1835
US

IV. Provider business mailing address

15621 W 87TH STREET PKWY STE 221
LENEXA KS
66219-1435
US

V. Phone/Fax

Practice location:
  • Phone: 913-777-0077
  • Fax: 877-796-6309
Mailing address:
  • Phone: 913-777-0077
  • Fax: 877-796-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-28951
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number0428951
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number104177
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: