Provider Demographics
NPI:1417940313
Name:LANKACHANDRA, BHARATA (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARATA
Middle Name:
Last Name:LANKACHANDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BHARATA
Other - Middle Name:KADUPITIGE ARYARATNA
Other - Last Name:LANKACHANDRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:10901 GRANADA LN
Mailing Address - Street 2:#200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1401
Mailing Address - Country:US
Mailing Address - Phone:913-660-1616
Mailing Address - Fax:913-660-1664
Practice Address - Street 1:10500 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-541-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106838207R00000X
KS04-26655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100376130BMedicaid
MO207739541Medicaid
21278014OtherBCBS
337910OtherFIRST GUARD
MO110231988OtherRR MCR
2499564OtherAETNA
KS100376130AMedicaid
738519OtherFIRST HEALTH
738519OtherFIRST HEALTH
F57358Medicare UPIN
KSI147344Medicare PIN
MO207739541Medicaid