Individual
EDWARD F ELLERBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3901 RAINBOW BLVD DELP 6040 MS 1020, KANSAS UNIVERSITY PHYSICIANS INC, KANSAS CITY, KS 66160-0001
(913) 588-3974
(913) 588-6055
Mailing address
KANSAS UNIVERSITY PHYSICIANS INC, 3901 RAINBOW BLVD, 4070 DELP, MAIL STOP 4017, KANSAS CITY, KS 66160-0001
(913) 588-2500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
04-20890
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100181080A
—
KS
01
—
11549075
BCBS KC
MO
05
—
202115010
—
MO
01
—
625720
FIRSTGUARD
KS
Enumeration date
10/04/2006
Last updated
12/29/2014
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