Provider Demographics
NPI:1710978705
Name:ARVAN, ANDREA A (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:A
Last Name:ARVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 NALL AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2503
Mailing Address - Country:US
Mailing Address - Phone:913-319-7300
Mailing Address - Fax:913-498-1551
Practice Address - Street 1:12140 NALL AVE STE 125
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2503
Practice Address - Country:US
Practice Address - Phone:913-319-7300
Practice Address - Fax:913-498-1551
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111706207R00000X
KS04-26499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200307370Medicaid
MO208404400Medicaid
MO208404400Medicaid
MO5239488Medicare ID - Type UnspecifiedMEDICARE - KANSAS
MO5239488Medicare ID - Type UnspecifiedMEDICARE - MISSOURI