Provider Demographics
NPI:1184734816
Name:ELY, ANDREA M (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:ELY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 ROE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2538
Mailing Address - Country:US
Mailing Address - Phone:913-432-2080
Mailing Address - Fax:913-432-5183
Practice Address - Street 1:5675 ROE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-2538
Practice Address - Country:US
Practice Address - Phone:913-432-2080
Practice Address - Fax:913-432-5183
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-302342083P0901X, 207R00000X
KS0430234208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209123108Medicaid
MO32859026OtherBCBS KANSAS CITY
KS100641200AMedicaid
KS520670OtherFIRSTGUARD
KS520670OtherFIRSTGUARD
MO32859026OtherBCBS KANSAS CITY
KSP00057964Medicare ID - Type UnspecifiedRAILROAD MEDICARE