Provider Demographics
NPI:1164475851
Name:HERRICK, PATRICK R (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:HERRICK
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 1:15435 WEST 134TH PL
Mailing Address - Street 2:STE 103
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-782-7515
Mailing Address - Fax:913-782-2942
Practice Address - Street 1:15435 WEST 134TH PL
Practice Address - Street 2:STE 103
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:913-782-7515
Practice Address - Fax:913-782-2942
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0425701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100177310AMedicaid
F77826Medicare UPIN
KS0338844DMedicare ID - Type Unspecified