Provider Demographics
NPI:1346318417
Name:EHLY, CHRISTOPHER JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAY
Last Name:EHLY
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 1:7301 MISSION RD STE 319
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3006
Mailing Address - Country:US
Mailing Address - Phone:913-513-2880
Mailing Address - Fax:913-600-4350
Practice Address - Street 1:7301 MISSION RD STE 319
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3006
Practice Address - Country:US
Practice Address - Phone:913-513-2880
Practice Address - Fax:913-600-4350
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422914207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100356240CMedicaid
E92458Medicare UPIN
C482991Medicare ID - Type Unspecified