Individual
CONSTANCE M IRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15270 W 119TH ST, OLATHE, KS 66062-5604
(913) 829-8833
(913) 768-4827
Mailing address
15270 W 119TH ST, OLATHE, KS 66062-5604
(913) 829-8833
(913) 768-4827
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-22030
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13429045
BCBSKC
—
Enumeration date
09/16/2005
Last updated
02/12/2010
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