Provider Demographics
NPI:1043282643
Name:LENTELL, MICHELLE DIANE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:LENTELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 W 119TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3724
Mailing Address - Country:US
Mailing Address - Phone:913-491-4020
Mailing Address - Fax:913-722-4385
Practice Address - Street 1:5525 W 119TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3724
Practice Address - Country:US
Practice Address - Phone:913-491-4020
Practice Address - Fax:913-722-4385
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100153410AMedicaid
KS100153410AMedicaid
KSF59043Medicare UPIN