Basic Information
| Provider Information | |||||||||
| NPI: | 1528000429 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLY | ||||||||
| FirstName: | ANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6650 TROOST AVE | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641311215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6650 TROOST AVE | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641311215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R9490 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201019551 | 05 | MO | MEDICAID | 100179970B | 05 | KS | MEDICAID |