Healthcare Provider Details

I. General information

NPI: 1245221159
Provider Name (Legal Business Name): MARIE A DELCAMBRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12140 NALL AVE SUITE 125
OVERLAND PARK KS
66209
US

IV. Provider business mailing address

PO BOX 22236
BELFAST ME
04915
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-8500
  • Fax: 913-498-1551
Mailing address:
  • Phone: 913-451-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR3E02
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-20883
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: