Provider Demographics
NPI:1518993286
Name:MOREANO, PHILLIP A (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:A
Last Name:MOREANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:325 MAINE STREET
Mailing Address - Street 2:MSO LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1335
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-5228
Practice Address - Street 1:330 ARKANSAS ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1335
Practice Address - Country:US
Practice Address - Phone:785-505-4950
Practice Address - Fax:785-505-5240
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-24709207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2050928302Medicaid
KS2050928302Medicaid
KSG29562Medicare UPIN