Provider Demographics
NPI:1538125539
Name:SHIPMAN, LANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:SHIPMAN
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 1:5808 W 110TH ST
Mailing Address - Street 2:ATTN: CMS URGENT CARE CENTER
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2504
Mailing Address - Country:US
Mailing Address - Phone:913-696-8228
Mailing Address - Fax:
Practice Address - Street 1:5808 W 110TH ST
Practice Address - Street 2:ATTN: CMS URGENT CARE CENTER
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2504
Practice Address - Country:US
Practice Address - Phone:913-696-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428220208000000X
MO110921208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100349700BMedicaid
KS100349700BMedicaid
H04768Medicare UPIN