Provider Demographics
NPI:1356437875
Name:ELLERBECK, EDWARD F (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:F
Last Name:ELLERBECK
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:KANSAS UNIVERSITY PHYSICIANS INC
Mailing Address - Street 2:3901 RAINBOW BLVD, 4070 DELP, MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-2500
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD DELP 6040 MS 1020
Practice Address - Street 2:KANSAS UNIVERSITY PHYSICIANS INC
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-3974
Practice Address - Fax:913-588-6055
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11549075OtherBCBS KC
KS625720OtherFIRSTGUARD
KS100181080AMedicaid
MO202115010Medicaid
KS110121083Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MO202115010Medicaid
KS0115431AMedicare ID - Type Unspecified