Provider Demographics
NPI:1437311354
Name:ROSE, CANDICE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:ELIZABETH
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:ELIZABETH
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:4023 WESCOE MAILSTOP 2024
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6022
Mailing Address - Fax:913-588-4060
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:4023 WESCOE MAILSTOP 2024
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6022
Practice Address - Fax:913-535-2101
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9407020207R00000X
KS04-36466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine