Provider Demographics
NPI:1134112048
Name:LEDNICKY, JAY A (MD)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:A
Last Name:LEDNICKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 GRANADA LN
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1401
Mailing Address - Country:US
Mailing Address - Phone:913-660-1616
Mailing Address - Fax:913-660-1664
Practice Address - Street 1:10901 GRANADA LN
Practice Address - Street 2:#200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1401
Practice Address - Country:US
Practice Address - Phone:913-660-1616
Practice Address - Fax:913-660-1664
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7H48207R00000X
KS04-31905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13988062OtherBCBS
4103158OtherAETNA
4103158OtherAETNA
P00170692Medicare ID - Type UnspecifiedRR MCR
MOI147245BMedicare ID - Type UnspecifiedRURAL MO
13988062OtherBCBS
MOI147245AMedicare ID - Type Unspecified