Individual
DR. LYNN DANIEL KETCHUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11111 NALL AVE, SUITE 114, LEAWOOD, KS 66211-1925
(913) 451-8567
(913) 451-8568
Mailing address
11111 NALL AVE, SUITE 114, LEAWOOD, KS 66211-1925
(913) 451-8567
(913) 451-8568
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
04-14119
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000026293
BCBS OF KANSAS
KS
01
—
07649010
BCBS OF KANSAS CITY
KS
Enumeration date
07/18/2005
Last updated
10/28/2008
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