Provider Demographics
NPI:1538509724
Name:MCCOLLUM, WILLIAM BALLEW (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BALLEW
Last Name:MCCOLLUM
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 1:1200 5TH AVE.
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048
Mailing Address - Country:US
Mailing Address - Phone:913-912-9630
Mailing Address - Fax:913-682-3880
Practice Address - Street 1:601 E. 12TH ST.
Practice Address - Street 2:12TH FLOOR
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106
Practice Address - Country:US
Practice Address - Phone:816-936-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13926202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner