Provider Demographics
NPI:1477655785
Name:KALLENBACH, LYNNE E (MD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:E
Last Name:KALLENBACH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:913-451-8500
Mailing Address - Fax:913-451-8575
Practice Address - Street 1:12140 NALL AVE
Practice Address - Street 2:STE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2503
Practice Address - Country:US
Practice Address - Phone:913-451-8500
Practice Address - Fax:913-451-8575
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2016-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-30715207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS927267OtherFIRSTGUARD
KS100066940BMedicaid
MO35463015OtherBCBS KC
MO207217308Medicaid
KSP00242119Medicare ID - Type UnspecifiedRAILROAD MEDICARE
I31944Medicare UPIN
MO35463015OtherBCBS KC