Provider Demographics
NPI:1730506684
Name:SLACK, ANIESA (MD)
Entity type:Individual
Prefix:DR
First Name:ANIESA
Middle Name:
Last Name:SLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5675 ROE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2538
Mailing Address - Country:US
Mailing Address - Phone:913-432-3780
Mailing Address - Fax:913-432-8463
Practice Address - Street 1:10950 W 86TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1634
Practice Address - Country:US
Practice Address - Phone:913-722-4240
Practice Address - Fax:913-721-0298
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-52035207Q00000X
MO2017020535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine