Provider Demographics
NPI:1174510549
Name:DICKIE, JAMES D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:DICKIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11755 W 112TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2761
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-338-1311
Practice Address - Street 1:12210 W 87TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2812
Practice Address - Country:US
Practice Address - Phone:913-438-6700
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0427433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69155Medicare UPIN
5538347AMedicare ID - Type Unspecified