Provider Demographics
NPI:1477674265
Name:TAMANO, ELY MIGHT AURE (MD)
Entity Type:Individual
Prefix:
First Name:ELY
Middle Name:MIGHT AURE
Last Name:TAMANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ELY
Other - Middle Name:AURE
Other - Last Name:TAMANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8900 STATE LINE RD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1960
Mailing Address - Country:US
Mailing Address - Phone:913-385-7252
Mailing Address - Fax:913-385-2412
Practice Address - Street 1:8900 STATE LINE RD
Practice Address - Street 2:SUITE 380
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1960
Practice Address - Country:US
Practice Address - Phone:913-385-7252
Practice Address - Fax:913-385-2412
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04332992084P0800X
MO20080219872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
42278029OtherBCBS
42278029OtherBCBS
MOA91000009Medicare PIN
MOA91B00001Medicare PIN