Provider Demographics
NPI:1568687549
Name:FLANAGAN, JEREMY R (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:R
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9200 INDIAN CREEK PKWY
Mailing Address - Street 2:BLDG. 9, STE. 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2002
Mailing Address - Country:US
Mailing Address - Phone:913-574-2800
Mailing Address - Fax:913-574-2336
Practice Address - Street 1:8700 NORTH GREEN HILLS RD.
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154
Practice Address - Country:US
Practice Address - Phone:913-574-2520
Practice Address - Fax:913-574-2612
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007012285207RH0003X
KS04-32454207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200436300BMedicaid
MO1568687549Medicaid
MO1568687549Medicaid
MOP00975481Medicare PIN
MOMA3347023Medicare PIN