MEDICARE: LYNN D. KETCHUM, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	04-14119	KS

General Provider Information

NPI Number	:	1750563458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNN D. KETCHUM, M.D.

Provider Business Mailing Address
First Line	:	11111 NALL AVE
Second Line	:	STE 114
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1625
Country	:	US
Telephone Number	:	913-451-8567
Fax Number	:	913-451-8568

Provider Business Practice Location Address
First Line	:	11111 NALL AVE
Second Line	:	STE 114
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1625
Country	:	US
Telephone Number	:	913-451-8567
Fax Number	:	913-451-8568

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	LYNN DANIEL KETCHUM
Credential	:	M.D.
Telephone Number	:	913-451-8567

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	10/27/2008

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