Provider Demographics
NPI:1891866018
Name:WIMMER, ALAN P (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:P
Last Name:WIMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4330 WORNALL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007008383207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207282708Medicaid
KS200428560FMedicaid
KSP00842696OtherRAILROAD MEDICARE
KS200428560A KANSASMedicaid
KS200428560GMedicaid
KS200428560D LEAVENWORMedicaid
KS200428560B OVRLND PKMedicaid
KSKA1021025OtherMEDICARE - CUSHING
MOP00836122OtherRAILROAD MEDICARE
MOMA2492003Medicare PIN
KSKA2004038Medicare PIN
KSKA1724038Medicare PIN
MOMA2491003Medicare PIN