Provider Demographics
NPI:1932114741
Name:SHEVLIN, DOUGLAS WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:SHEVLIN
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 1:14425 COLLEGE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2317
Mailing Address - Country:US
Mailing Address - Phone:913-348-2565
Mailing Address - Fax:
Practice Address - Street 1:9705 LENEXA DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1345
Practice Address - Country:US
Practice Address - Phone:913-348-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013018617207ZP0102X
IL036093225207ZP0102X
KS0436540207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360932252OtherMEDICAID
KS201073120AOtherKS MEDICAID
MO2013018617OtherMO LICENSE
LAPENDINGOtherLA LICENSE