Provider Demographics
NPI:1407841554
Name:ANDES, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:ANDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17221 E 23RD ST S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1803
Mailing Address - Country:US
Mailing Address - Phone:816-350-0005
Mailing Address - Fax:816-350-0015
Practice Address - Street 1:17221 E 23RD ST S
Practice Address - Street 2:SUITE 100
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1803
Practice Address - Country:US
Practice Address - Phone:816-350-0005
Practice Address - Fax:816-350-0015
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD R7B15207R00000X
KS04-23500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100453390BMedicaid
MO201584828Medicaid
MO201584836Medicaid
MO201584836Medicaid
MO201584828Medicaid