Provider Demographics
NPI:1265488225
Name:PINZUR, YELENA (DO)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:PINZUR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1553
Mailing Address - Country:US
Mailing Address - Phone:913-383-9099
Mailing Address - Fax:913-383-3103
Practice Address - Street 1:8800 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1553
Practice Address - Country:US
Practice Address - Phone:913-383-9099
Practice Address - Fax:816-383-3103
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002012690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00009825OtherRAILROAD MEDICARE
MO245988209Medicaid
230C018Medicare ID - Type Unspecified
H69896Medicare UPIN