Healthcare Provider Details

I. General information

NPI: 1942422936
Provider Name (Legal Business Name): ROBERT EVANGELIDIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
OVERLAND PARK KS
66204-4004
US

IV. Provider business mailing address

10540 MARTY ST SUITE 100
OVERLAND PARK KS
66212-2551
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2000
  • Fax:
Mailing address:
  • Phone: 913-660-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-32560
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007014753
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: