Provider Demographics
NPI:1518922897
Name:QUANN, PHILIP J (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:QUANN
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 COLLEGE BLVD
Mailing Address - Street 2:STE. 110
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1937
Mailing Address - Country:US
Mailing Address - Phone:913-341-6297
Mailing Address - Fax:913-341-6299
Practice Address - Street 1:7301 COLLEGE BLVD
Practice Address - Street 2:STE. 110
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1937
Practice Address - Country:US
Practice Address - Phone:913-341-6297
Practice Address - Fax:913-341-6299
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1569207ZP0105X
IL036123660207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
44577011OtherBCBS-KC
KS200671300AMedicaid
MO1518922897Medicaid
KS200671300AMedicaid
MOG97000005Medicare PIN